The Role of Arthroplasty in Acute and Failed Fracture Surgery Around the Knee

Total knee arthroplasty (TKA) has become an increasingly valuable solution for managing acute periarticular fractures and failed fixation, particularly in elderly patients with severe comminution or underlying arthritis. Its key advantage lies in enabling immediate weight bearing and potentially reducing the need for reoperation compared with traditional fixation methods such as open reduction and internal fixation or intramedullary nailing. Although open reduction and internal fixation and intramedullary nailing remain standard fixation methods for many fracture types, primary TKA is gaining traction as a definitive treatment in complex cases. TKA, although technically demanding in these settings, offers reliable restoration of function when guided by thorough preoperative planning. TKA is no longer confined to salvage scenarios; it is evolving into a primary option that merges trauma principles with arthroplasty expertise. It is important to critically examine the role of TKA in fracture management, with a focus on patient selection, surgical technique, postoperative care, and outcomes to optimize results in both primary and revision settings.