Issue: July 2012
July 03, 2012
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Study shows higher 5- and 10- year risks of TKA after ORIF of tibial plateau fractures

Issue: July 2012
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The results of a matched cohort study indicate a five times higher risk of total knee arthroplasty at 10 years among patients treated for tibial plateau fractures with open reduction and internal fixation compared to the general population.

“We adjusted for comorbidities and the specific risk of a plateau fracture leading to total knee arthroplasty was 5.3 times,” study investigator Richard J. Jenkinson, MD, FRCS(C), said. “When we looked at the factors predicting knee replacement among the fracture patients, age, female gender and comorbidities were all associated with higher knee replacement rates.” Jenkinson presented the results of the population-based matched cohort study at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.

Jenkinson and colleagues conducted their study to examine the risk of total knee arthroplasty (TKA) in patients treated with open reduction and internal fixation (ORIF) for tibial plateau fractures compared to the general population and to highlight the factors associated with an increased risk for subsequent TKA following these operatively fixed fractures.

Using databases centralized at the Institute for Clinical Evaluative Sciences in Toronto, Ontario, Canada, the researchers identified 8,400 patients older than 16 years who underwent ORIF for tibial plateau fractures between July 1996 and March 2010 and matched them to controls for age, gender, income quintile, urban/rural address and year of fracture. Excluded from the study were patients with bilateral injuries, non-Ontario residents and those with codes indicating TKA or ORIF “at the time of surgery or within 5 years prior to July 1996 of tibial plateau fracture,” Jenkinson said. Patients had a mean age of 49 years and investigators compared the rates of TKA at 2 years, 5 years and 10 years after the index procedure.

The investigators found similar TKA rates for the groups at 2 years (0.32% in the ORIF group vs. 0.29% in the control group). At 5 years and 10 years, the ORIF group had TKA rates of 5.3% and 7.3%, respectively. The controls had rates of 0.82% and 1.8% for those time points. More than 92% of patients in the ORIF group retained their native knees at 10 years compared to 98.2% of controls.

Jenkinson noted that study limitations included the use of information obtained from databases that excluded details on the quality of reduction, postoperative alignment, stability, injury characteristics and surgical tactics.

“We cannot really capture patients that have problems, but are not candidates for total knee replacements,” he said. – by Renee Blisard Buddle

Reference:
  • Wasserstein D, Kreder H, Paterson M, et al. A population-based matched cohort study of total knee replacement after operatively fixed tibial plateau fractures. Paper #184. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
For more information:
  • Richard J. Jenkinson, MD, FRCS(C), can be reached at the University of Toronto, MG361, 2075 Bayview Ave., Toronto, Canada M4N 3MS; email: richard.jenkinson@sunnybrook.ca.
Disclosure:
  • Jenkinson has no relevant financial disclosures.