Total Knee Replacement Versus Osteosynthesis as Primary Treatment in Older Patients with Tibial Plateau Fracture

The treatment of tibial plateau fractures is a challenge in the elderly population due to osteoporosis and associated comorbidities. The choice between open reduction and internal fixation (ORIF) and total knee replacement (TKR) is controversial. The aim of this study is to compare functional outcomes between TKR and ORIF in elderly patients with tibial plateau fractures.

A retrospective observational study was conducted on 27 elderly patients with Schatzker type II, III, or IV tibial plateau fractures treated between January 2018 and December 2022, with prior history of osteoporosis or gonarthrosis. 14 patients underwent treatment with TKR, while 15 patients underwent ORIF. Demographic data, pre-operative characteristics, surgical details, post-operative evolution, and functional outcomes were collected and analyzed.

The TKR group consisted mostly of women (92.9%) with a mean age of 76 years, while the ORIF group had a mean age of 68 years. Both groups had similar comorbidity profiles. No significant differences were observed in the mean surgical time (P = 0.18). Significant differences were found between the knee society score (KSS) knee score for total knee arthroplasty (TKA) and ORIF (P = 0.01) and in the KSS function score, with better functional values in the TKA group compared to the ORIF group (P = 0.034). No significant differences were observed in the probability of complications regardless of whether the patients underwent TKA or ORIF (P = 0.6).

Treatment of tibial plateau fractures with TKR achieves superior functional outcomes and lower complication rates compared to open reduction and internal fixation in elderly patients.