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. 2022 Nov;142(11):3257-3264.
doi: 10.1007/s00402-021-04150-1. Epub 2021 Aug 31.

Primary total knee replacement for tibial plateau fractures in older patients: a systematic review of 197 patients

V Tapper  1 , A Toom  2 , K Pamilo  2 , T Niinimäki  3 , J Nieminen  4 , S Nurmi  5 , T Kortekangas  3 , J Paloneva  2   6
Affiliations

Primary total knee replacement for tibial plateau fractures in older patients: a systematic review of 197 patients

V Tapper et al. Arch Orthop Trauma Surg. 2022 Nov.

Abstract

Introduction: Tibial plateau fractures are typically treated with osteosynthesis. In older patients, osteosynthesis is associated with some complications, risk of post-traumatic osteoarthritis and long partial, or non-weight bearing during the recovery phase. To avoid these problems, primary total knee replacement (TKR) has become an increasingly common treatment option. The aim of this study was to evaluate all the relevant literature and summarize the current evidence-based knowledge on the treatment of tibial plateau fractures with primary TKR in older patients.

Materials and methods: A systematic literature search of studies on total knee replacement (TKR) as primary treatment for acute traumatic tibial plateau fracture was conducted using OVID Medline, Scopus, and Cochrane databases from 1946 to 18 November 2019. We included all studies without restrictions regarding total knee replacement (TKR) as primary treatment for acute traumatic tibial plateau fracture.

Results: Of the 640 reviewed articles, 16 studies with a total of 197 patients met the inclusion criteria. No controlled trials were available, and the overall quality of the literature was low. The results, using different clinical scoring systems, were good or fair. Four-year follow-up complication (6.1%) and revision (3.6%) rates after primary TKR appeared to be lower than after secondary TKR (complication rate 20-48%, revision rate 8-20%) but higher than after elective primary TKR.

Conclusion: Based on low-quality evidence, TKR appears to be a useful treatment option for tibial plateau fractures in older patients. Controlled trials are mandatory to determine the relative superiority of these two options as primary treatment of tibial plateau fractures in older patients.

Keywords: Knee; Osteosynthesis; Primary total knee replacement; Surgery; Tibial plateau fracture; Total knee replacement.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
See this image and copyright information in PMC

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