Long-term results of reconstructive surgery in posttraumatic deformities of the proximal epymetaphysis of the tibia

BACKGROUND: Tibial plateau fractures (TPF) are common and account for up to 1% of all fractures. The most unfavorable results of their treatment occur with nonunion, malunion, and malunion of TPF fractures. Unfavorable functional results of treatment are due to the occurrence of stiffness in the joint, the development of post-traumatic osteoarthritis, instability in the joint and the presence of infectious complications. In this case, there are indications for surgical treatment of intraarticular fractures of TPF.

AIM: to evaluate long-term results and factors leading to knee arthroplasty after reconstructive surgery for post-traumatic deformities of the proximal tibial epimetaphysis.

MATERIALS AND METHODS: The long-term (in terms of 5 to 10 years) treatment results were assessed in 46 patients with malunion of intra-articular fractures of the tibial plateau, operated in the period from 2010 to 2015.The average age of patients was 47.6±11 years. We considered both cases of neglected conservative treatment (87%) and cases with unsuccessful surgical fixation (13%).

RESULTS: The KOOS pain score was 75.0 [66.6; 94.0] points, which corresponds to a good result. Satisfactory results were observed during the examination on the basis of “daily physical activity” (66.1 [51.5; 85.3] points) and on the basis of “symptoms and stiffness” (65.4 [53.6; 86.0] points). Average scores for the attribute “physical activity while playing sports, games and entertainment” and for the attribute “quality of life” — 53.75 [25.0; 81.0] and 53.8 [25.0; 81.0] points, respectively, were assessed as unsatisfactory. In terms of up to 10 years, 5 out of 46 patients (10.9%) underwent knee arthroplasty. A statistically significant relationship was determined between the varus deformity more than 3° persisting after reconstructive surgery (r=0.664, p <0.0001), the time period between injury and reconstructive surgery (r=0.262, p=0.007) and the appearance of indications for TKA.

CONCLUSION: The study revealed a statistically significant direct correlation relationships between persisting varus deformity more than 3°, as well as a long time interval between injury and the performed reconstructive surgery with the emergence of indications for arthroplasty.