Total knee replacement after fractures about the knee.

We reviewed 17 cases of posttraumatic arthritis after fractures about the knee. All patients underwent total knee replacement; one had a distal femoral osteotomy to correct a deformity prior to arthroplasty. Thirteen patients had a minimum one-year follow-up, with an average follow-up of 27 months (range, one to four years). Of these, eight were considered to have a successful clinical result. All five patients with unsuccessful results had major intraoperative and/or postoperative complications. In malunions of intra-articular fractures of the proximal tibia, the important technical consideration for planned total knee replacement is preoperative tilt of the tibial plateau in the antero-posterior (AP) and lateral radiographic views. Tibial plateau tilt should be recognized during preoperative planning, and intraoperative adjustments are required. In malunions of extra-articular fractures of the distal femur or proximal tibia, a varus or valgus deformity is an important consideration. Prearthroplasty osteotomy may be considered in a patient with a significant bony deformity above or below the joint line. Incisions should be carefully planned, especially when a previous lateral distal femoral approach has been performed. The results may resemble revision rather than primary arthroplasty.