title: Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review.
abstract: Posttraumatic osteoarthritis (PTOA) of the knee is a common complication after intra- and extra-articular fractures. Moreover, PTOA may also be a result of isolated cartilage defects, meniscus resections, and ligament injuries. There are various methods of treatment of knee joint fractures. However, in the final stage of a PTOA, when nonoperative treatment fails, endoprosthetic joint replacement is the method of choice. Primary total knee replacement (TKR) for the treatment for a fracture of the knee joint is a rare indication, even at major treatment centers. It is performed in elderly patients with the inability to be mobilized with partial- or non-weight bearing; in cases with considerable bone destruction; in cases with symptomatic osteoarthritis (OA) in the elderly; and, it is often associated with the primary use of a modular implant. However, TKR in the acute situation should always be an individual decision. Secondary TKR after knee joint fracture shows overall good functional results. However, the results are inferior when compared with TKR for primary OA. In addition, the complication rates of TKR for PTOA are much higher. Problems with the extensor mechanism after tibial plateau fractures are common. There are also problems caused by preexisting scars, nonunion (possibly due to a low grade infection), malalignment, restricted movement, or instability.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, Sana Kliniken Leipziger Land, Borna, Germany. Electronic address: kontakt@matthias-aurich.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Aurich
authors.affiliation: Department Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Koenig
authors.affiliation: Department Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany; BG Trauma Center Bergmannstrost, Halle, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Hofmann
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D018460:Fractures, Comminuted / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function; D013978:Tibial Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: joint replacement; knee; osteoarthritis; trauma