[Posttraumatic knee osteoarthritis in the geriatric patient : Strategies for conversion to total knee arthroplasty after tibial plateau fractures].

Tibial plateau fractures are severe injuries of the knee joint and oftentimes lead to the development of posttraumatic osteoarthritis. A proportion of patients therefore requires secondary arthroplasty. Total knee arthroplasty after tibial plateau fracture, however, carries a markedly higher risk for complications when compared to primary arthroplasty, especially in geriatric patients. Bone defects, malalignment, instability, and a higher infection rate are major concerns in this subset of patients. Retained hardware and compromised soft tissues may further complicate surgical treatment. Careful preoperative surgical planning is therefore essential. Implant design, augmentation, and degree of constraint have to be adapted to individual soft-tissue tension and bony defects. Osseous defects are classified using the Anderson Orthopaedic Research Institute (AORI) classification and implant fixation is facilitated by respecting the concept of zonal fixation. Modern technologies such as robotic surgery systems and patient-specific instrumentation may further reduce surgical complexity in difficult cases. The following article provides an overview of challenges and surgical strategies in total knee arthroplasty after tibial plateau fractures. Three cases illustrate specific challenges and individualized treatment options.