Abstract
To determine if radiographic evidence of posttraumatic osteoarthritis (PTOA) following
tibial plateau fracture correlates with poorer clinical and functional outcomes, patients
with tibial plateau fractures were followed at 3, 6, and 12 months. All patients had
baseline radiographs and computed tomography scan. Radiographs obtained at each follow-up
were reviewed for healing, articular incongruence, hardware positional changes, and
the development of postinjury arthritic change. Cohorts were determined based on the
presence (PTOA) or absence (NPTOA) of radiographic evidence of PTOA. Demographics,
fracture classification, complications, additional procedures, and functional status
were compared between cohorts. Sixty patients had radiographic evidence of PTOA on
follow-up radiographs at a mean final follow-up of 24.2 months. The NPTOA cohort was
composed of 210 patients who were matched to the PTOA cohort based on age and Charlson
comorbidity index. Mean time to fracture union for the overall cohort was 4.86 months.
Cohorts did not differ in Schatzker classification, time to healing, injury mechanism,
or baseline Short Musculoskeletal Function Assessment (SMFA). Patients with PTOA had
a greater degree of initial depression and postoperative step-off, higher incidence
of initial external fixator usage, higher rates of reoperation for any reason, and
higher rates of wound complications. Associated soft tissue injury and meniscal repair
did not coincide with the development of PTOA. Range of motion and SMFA scores were
significantly worse at all time points in patients with PTOA. Although fracture patterns
are similar, patients who required an initial external fixator, had a greater degree
of initial depression or residual articular incongruity, underwent more procedures,
and developed an infection were found to have increased incidence of PTOA. Radiographic
evidence of osteoarthritis correlated with worse functional status in patients. The
goal of surgery should be restoration of articular congruity and stability to mitigate
the risk of PTOA, although this alone may not prevent degenerative changes. Patients
with early loss of range of motion should be aggressively treated as this may precede
the development of PTOA.
Keywords
osteoarthritis - posttraumatic arthritis - tibial plateau - PTOA
