Patients undergoing total knee arthroplasty after tibial plateau fracture show functional improvement similar to primary arthroplasty patients: Propensity-matched cohort analysis

Purpose: Patients with a previous tibial plateau fracture (post-TPF) may be susceptible to worse outcomes after total knee arthroplasty (TKA) than patients undergoing primary TKA (pTKA). However, there is limited comparative evidence on patient-reported outcomes (PROMs) of these cohorts. This study aimed to compare PROMs and rate of achieving Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) between post-TPF TKA and pTKA patients. Methods: Thirty-three post-TPF TKA patients were identified from an institutional database between 2016 and 2023 and 1:3 propensity score matched to 97 pTKA patients treated in the same period. Outcomes included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Mental and Physical, PROMIS Physical Function short form 10a (PF SF 10a), and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) scores. Results: Post-TPF TKA patients had significantly lower preoperative scores on PROMIS Global Health Mental (47.8 vs. 51.4, P = .042) and PF SF 10a (35.5 vs. 37.5, P = .037) compared to pTKA patients. The absolute increase across all PROMs between the cohorts was similar, however, post-TPF TKA patients had a higher rate of achieving MCID-I for PROMIS Global Health Mental and PF SF 10a. Post-TPF TKA patients had a higher rate of 90-day complications (15 vs. 4%, P = .031). Conclusion: Post-TPF TKA patients reached higher MCID-I rates in two PROMs, but had significantly higher complication rates compared to pTKA. Despite the risks, post-TPF TKA patients can achieve similar or better improvements, urging further research into long-term outcomes for effective patient counseling and shared decision-making.