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Primary Versus Secondary Total Knee Arthroplasty for Tibial Plateau Fractures in Patients Aged 55 or Over-A Systematic Review and Meta-Analysis.

Authors
  • Makaram, Navnit S1
  • Param, Aava2
  • Clement, Nicholas D3
  • Scott, Chloe E H3
  • 1 Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; The University of Edinburgh, Edinburgh, United Kingdom. , (United Kingdom)
  • 2 The University of Edinburgh, Edinburgh, United Kingdom. , (United Kingdom)
  • 3 Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. , (United Kingdom)
Type
Published Article
Journal
The Journal of arthroplasty
Publication Date
Feb 01, 2024
Volume
39
Issue
2
Pages
559–567
Identifiers
DOI: 10.1016/j.arth.2023.08.016
PMID: 37572727
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Total knee arthroplasty allows immediate postoperative weight-bearing and is increasingly recognized as a suitable treatment option for older patients who have tibial plateau fractures (TPFs). This systematic review evaluated the clinical and functional outcomes associated with primary versus secondary TKA for the treatment of TPFs in patients aged ≥55 years. Various databases were searched from inception to December 2021. Studies investigating outcomes of primary TKA (pTKA) as the initial treatment for TPFs in patients of mean age ≥55 years or those investigating outcomes of secondary TKA (sTKA) following any other primary treatment for TPFs were included. Quality of included studies was assessed using a methodological scale. Of 767 potentially relevant studies, 12 studies comprising 341 patients were included: 121 patients underwent (pTKA) and 220 patients underwent sTKA. There were 3 high-quality studies. Patients in the sTKA cohort were significantly younger at the time of TKA compared with those undergoing pTKA (mean 61.3 versus 72.2 years, P < .001, 95% confidence interval (CI) 8.2 to 13.6). Intraoperative and postoperative complication rates were lower with pTKA; in particular, sTKA was associated with a significantly increased rate of stiffness requiring reintervention and patella tendon rupture. Functional outcome was greater after pTKA, but this did not reach statistical significance (85.2 versus 79.9%, P = .359, 95% CI -16.7 to 6.1). Primary TKA was associated with lower complication rates than secondary TKA after TPF. In appropriate cases of TPF in older adults, it may be preferable to proceed with TKA as primary treatment rather than delaying until after fracture union or malunion. Copyright © 2023 Elsevier Inc. All rights reserved.

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