Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery: Results in a Large Multicenter Cohort

Nick Assink; Mostafa El Moumni; Joep Kraeima; Eelke Bosma; Robert J. Nijveldt; Sven H. Van Helden; Thijs P. Vaartjes; Joost G. Ten Brinke; Max J.H. Witjes; Jean Paul P.M. De Vries; Frank F.A. IJpma

doi:10.2106/JBJS.22.00500

Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery: Results in a Large Multicenter Cohort

Nick Assink^*, Mostafa El Moumni, Joep Kraeima, Eelke Bosma, Robert J. Nijveldt, Sven H. Van Helden, Thijs P. Vaartjes, Joost G. Ten Brinke, Max J.H. Witjes, Jean Paul P.M. De Vries, Frank F.A. IJpma^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Radiographic measurements of initial displacement of tibial plateau fractures and of postoperative reduction are used to determine treatment strategy and prognosis. We assessed the association between radiographic measurements and the risk of conversion to total knee arthroplasty (TKA) at the time of follow-up.

Methods: A total of 862 patients surgically treated for tibial plateau fractures between 2003 and 2018 were eligible for this multicenter cross-sectional study. Patients were approached for follow-up, and 477 (55%) responded. The initial gap and step-off were measured on the preoperative computed tomography (CT) scans of the responders. Condylar widening, residual incongruity, and coronal and sagittal alignment were measured on postoperative radiographs. Critical cutoff values for gap and step-off were determined using receiver operating characteristic curves. Postoperative reduction measurements were categorized as adequate or inadequate on the basis of cutoff values in international guidelines. Multivariable analysis was performed to assess the association between each radiographic measurement and conversion to TKA.

Results: Sixty-seven (14%) of the patients had conversion to TKA after a mean follow-up of 6.5 ± 4.1 years. Assessment of the preoperative CT scans revealed that a gap of >8.5 mm (hazard ratio [HR] = 2.6, p < 0.001) and step-off of >6.0 mm (HR = 3.0, p < 0.001) were independently associated with conversion to TKA. Assessment of the postoperative radiographs demonstrated that residual incongruity of 2 to 4 mm was not associated with increased risk of TKA compared with adequate fracture reduction of <2 mm (HR = 0.6, p = 0.176). Articular incongruity of >4 mm resulted in increased risk of TKA. Coronal (HR = 1.6, p = 0.05) and sagittal malalignment (HR = 3.7 p < 0.001) of the tibia were strongly associated with conversion to TKA.

Conclusions: Substantial preoperative fracture displacement was a strong predictor of conversion to TKA. Postoperative gaps or step-offs of >4 mm as well as inadequate alignment of the tibia were strongly associated with an increased risk of TKA.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original language	English
Pages (from-to)	1237-1245
Number of pages	9
Journal	Journal of Bone and Joint Surgery
Volume	105
Issue number	16
DOIs	https://doi.org/10.2106/JBJS.22.00500
Publication status	Published - 16-Aug-2023

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Assink, N., El Moumni, M., Kraeima, J., Bosma, E., Nijveldt, R. J., Van Helden, S. H., Vaartjes, T. P., Ten Brinke, J. G., Witjes, M. J. H., De Vries, J. P. P. M., & IJpma, F. F. A. (2023). Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery: Results in a Large Multicenter Cohort. Journal of Bone and Joint Surgery, 105(16), 1237-1245. https://doi.org/10.2106/JBJS.22.00500

@article{e2891e5949374f89a275ae504f78f5f5,

title = "Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery: Results in a Large Multicenter Cohort",

abstract = "Background: Radiographic measurements of initial displacement of tibial plateau fractures and of postoperative reduction are used to determine treatment strategy and prognosis. We assessed the association between radiographic measurements and the risk of conversion to total knee arthroplasty (TKA) at the time of follow-up.Methods: A total of 862 patients surgically treated for tibial plateau fractures between 2003 and 2018 were eligible for this multicenter cross-sectional study. Patients were approached for follow-up, and 477 (55%) responded. The initial gap and step-off were measured on the preoperative computed tomography (CT) scans of the responders. Condylar widening, residual incongruity, and coronal and sagittal alignment were measured on postoperative radiographs. Critical cutoff values for gap and step-off were determined using receiver operating characteristic curves. Postoperative reduction measurements were categorized as adequate or inadequate on the basis of cutoff values in international guidelines. Multivariable analysis was performed to assess the association between each radiographic measurement and conversion to TKA.Results: Sixty-seven (14%) of the patients had conversion to TKA after a mean follow-up of 6.5 ± 4.1 years. Assessment of the preoperative CT scans revealed that a gap of >8.5 mm (hazard ratio [HR] = 2.6, p < 0.001) and step-off of >6.0 mm (HR = 3.0, p < 0.001) were independently associated with conversion to TKA. Assessment of the postoperative radiographs demonstrated that residual incongruity of 2 to 4 mm was not associated with increased risk of TKA compared with adequate fracture reduction of <2 mm (HR = 0.6, p = 0.176). Articular incongruity of >4 mm resulted in increased risk of TKA. Coronal (HR = 1.6, p = 0.05) and sagittal malalignment (HR = 3.7 p < 0.001) of the tibia were strongly associated with conversion to TKA.Conclusions: Substantial preoperative fracture displacement was a strong predictor of conversion to TKA. Postoperative gaps or step-offs of >4 mm as well as inadequate alignment of the tibia were strongly associated with an increased risk of TKA.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.",

author = "Nick Assink and {El Moumni}, Mostafa and Joep Kraeima and Eelke Bosma and Nijveldt, {Robert J.} and {Van Helden}, {Sven H.} and Vaartjes, {Thijs P.} and {Ten Brinke}, {Joost G.} and Witjes, {Max J.H.} and {De Vries}, {Jean Paul P.M.} and IJpma, {Frank F.A.}",

year = "2023",

month = aug,

day = "16",

doi = "10.2106/JBJS.22.00500",

language = "English",

volume = "105",

pages = "1237--1245",

journal = "Journal of Bone and Joint Surgery",

issn = "0021-9355",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "16",

}

Assink, N , El Moumni, M , Kraeima, J, Bosma, E, Nijveldt, RJ, Van Helden, SH, Vaartjes, TP, Ten Brinke, JG, Witjes, MJH , De Vries, JPPM & IJpma, FFA 2023, 'Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery: Results in a Large Multicenter Cohort', Journal of Bone and Joint Surgery, vol. 105, no. 16, pp. 1237-1245. https://doi.org/10.2106/JBJS.22.00500

TY - JOUR

T1 - Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery

T2 - Results in a Large Multicenter Cohort

AU - Assink, Nick

AU - El Moumni, Mostafa

AU - Kraeima, Joep

AU - Bosma, Eelke

AU - Nijveldt, Robert J.

AU - Van Helden, Sven H.

AU - Vaartjes, Thijs P.

AU - Ten Brinke, Joost G.

AU - Witjes, Max J.H.

AU - De Vries, Jean Paul P.M.

AU - IJpma, Frank F.A.

PY - 2023/8/16

Y1 - 2023/8/16

N2 - Background: Radiographic measurements of initial displacement of tibial plateau fractures and of postoperative reduction are used to determine treatment strategy and prognosis. We assessed the association between radiographic measurements and the risk of conversion to total knee arthroplasty (TKA) at the time of follow-up.Methods: A total of 862 patients surgically treated for tibial plateau fractures between 2003 and 2018 were eligible for this multicenter cross-sectional study. Patients were approached for follow-up, and 477 (55%) responded. The initial gap and step-off were measured on the preoperative computed tomography (CT) scans of the responders. Condylar widening, residual incongruity, and coronal and sagittal alignment were measured on postoperative radiographs. Critical cutoff values for gap and step-off were determined using receiver operating characteristic curves. Postoperative reduction measurements were categorized as adequate or inadequate on the basis of cutoff values in international guidelines. Multivariable analysis was performed to assess the association between each radiographic measurement and conversion to TKA.Results: Sixty-seven (14%) of the patients had conversion to TKA after a mean follow-up of 6.5 ± 4.1 years. Assessment of the preoperative CT scans revealed that a gap of >8.5 mm (hazard ratio [HR] = 2.6, p < 0.001) and step-off of >6.0 mm (HR = 3.0, p < 0.001) were independently associated with conversion to TKA. Assessment of the postoperative radiographs demonstrated that residual incongruity of 2 to 4 mm was not associated with increased risk of TKA compared with adequate fracture reduction of <2 mm (HR = 0.6, p = 0.176). Articular incongruity of >4 mm resulted in increased risk of TKA. Coronal (HR = 1.6, p = 0.05) and sagittal malalignment (HR = 3.7 p < 0.001) of the tibia were strongly associated with conversion to TKA.Conclusions: Substantial preoperative fracture displacement was a strong predictor of conversion to TKA. Postoperative gaps or step-offs of >4 mm as well as inadequate alignment of the tibia were strongly associated with an increased risk of TKA.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Radiographic measurements of initial displacement of tibial plateau fractures and of postoperative reduction are used to determine treatment strategy and prognosis. We assessed the association between radiographic measurements and the risk of conversion to total knee arthroplasty (TKA) at the time of follow-up.Methods: A total of 862 patients surgically treated for tibial plateau fractures between 2003 and 2018 were eligible for this multicenter cross-sectional study. Patients were approached for follow-up, and 477 (55%) responded. The initial gap and step-off were measured on the preoperative computed tomography (CT) scans of the responders. Condylar widening, residual incongruity, and coronal and sagittal alignment were measured on postoperative radiographs. Critical cutoff values for gap and step-off were determined using receiver operating characteristic curves. Postoperative reduction measurements were categorized as adequate or inadequate on the basis of cutoff values in international guidelines. Multivariable analysis was performed to assess the association between each radiographic measurement and conversion to TKA.Results: Sixty-seven (14%) of the patients had conversion to TKA after a mean follow-up of 6.5 ± 4.1 years. Assessment of the preoperative CT scans revealed that a gap of >8.5 mm (hazard ratio [HR] = 2.6, p < 0.001) and step-off of >6.0 mm (HR = 3.0, p < 0.001) were independently associated with conversion to TKA. Assessment of the postoperative radiographs demonstrated that residual incongruity of 2 to 4 mm was not associated with increased risk of TKA compared with adequate fracture reduction of <2 mm (HR = 0.6, p = 0.176). Articular incongruity of >4 mm resulted in increased risk of TKA. Coronal (HR = 1.6, p = 0.05) and sagittal malalignment (HR = 3.7 p < 0.001) of the tibia were strongly associated with conversion to TKA.Conclusions: Substantial preoperative fracture displacement was a strong predictor of conversion to TKA. Postoperative gaps or step-offs of >4 mm as well as inadequate alignment of the tibia were strongly associated with an increased risk of TKA.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=85168222093&partnerID=8YFLogxK

U2 - 10.2106/JBJS.22.00500

DO - 10.2106/JBJS.22.00500

M3 - Article

C2 - 37196070

AN - SCOPUS:85168222093

SN - 0021-9355

VL - 105

SP - 1237

EP - 1245

JO - Journal of Bone and Joint Surgery

JF - Journal of Bone and Joint Surgery

IS - 16

ER -

Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery: Results in a Large Multicenter Cohort

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