Total knee arthroplasty for acute tibial plateau fractures: a survey amongst 68 Dutch orthopaedic surgeons

In older patients with highly comminuted intra-articular tibial plateau fractures (TPFs), primary total knee arthroplasty (TKA) may be a treatment option. Our aim was to report and rank decisional factors considered by Dutch orthopaedic trauma and knee surgeons that may lead to the decision for TKA as treatment for TPFs. A survey was distributed among 141 experts on traumatology and arthroplasty of the knee. The survey assessed the likelihood of TKA surgery after TPF in various patient and radiological characteristics. The level of experience with this of each responder was also noted. Descriptive statistics were calculated for all items. 141 participants were approached and 68 responded (48.2%). Responders were not more likely to proceed with TKA based on fracture types, impaired mobility, multiple incisions for ORIF, body mass index and ASA classification. However, in patients with pre-existing osteoarthritis (OA) and age ≥ 80 a majority would be more likely to proceed with TKA, with respectively 69.1% and 50.0%. The most strongly considered factors were the presence of pre-existing OA, the age of the patient and the type of fracture, with respectively 55.9%, 51.4% and 42.6% of responders ranking it in their top three most important factors. The study showed that the presence of pre-existing symptomatic OA and age of the patient were valued highest and increased the probability of a TKA in acute TPFs.