PubMed^® Literature Review

The literature on risk factors for conversion to total knee arthroplasty (TKA) after tibial plateau fracture (TPF) presents a multifaceted picture where patient demographics, fracture characteristics, surgical techniques, and postoperative management converge to influence outcomes [1-12].

The overall conversion rate from treated TPFs to TKA is reported at approximately 5%, with certain subgroups exhibiting higher rates [1]. Identified risk factors include female sex, advanced age at the time of injury or surgery [2], low surgeon and hospital volume [9], previous infection related to tibial plateau repair surgery not correlating with prosthetic joint infection but influencing incision placement decisions during subsequent TKA [2], substantial preoperative fracture displacement [3], inadequate postoperative coronal and sagittal alignment of the tibia [3], obesity [10], varus malalignment of the lower extremity [11] as well as osteoporosis contributing towards inclination of the tibial plateau in postmenopausal women with OA knee [8].

Radiographic predictors such as initial gap greater than 8.5 mm and step-off over 6.0 mm are strongly associated with increased risk for conversion to TKA after TPF surgery according to multivariable analyses; however residual incongruity between 2-4 mm was not found significantly associated when compared with adequate reduction under 2 mm—indicating that small degrees of articular surface mismatch may be tolerated without accelerating progression towards arthroplasty within observed follow-up periods[3].

Furthermore, patients who consumed tobacco were more likely to require joint replacement following ORIF for tibial plateau fractures; younger patients tended toward osteochondral allograft (OCA) transplantation rather than conventional TKA when addressing posttraumatic arthritis[7]. This indicates that lifestyle factors can also play a role in long-term outcomes following these injuries.

It has been suggested that high-volume treatment centers exhibit lower rates of conversion to TKA suggesting potential benefits in regionalizing care for complex injuries like TPFs[9]. Additionally, it is posited that elderly patients do not inherently face poorer radiographic outcomes or higher complication rates compared against their younger counterparts after ORIF indicating suitability across ages if other risk factors are managed appropriately[4].

Lastly, spontaneous osteonecrosis/subchondral insufficiency fractures which commonly present alongside medial meniscal root tears can progress toward arthroplasty at notable rates especially among older individuals demonstrating baseline arthritis along with varus alignment issues further complicating prognosis even outside direct traumatic contexts such as acute TPFS[12].