Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.115881
Revised: November 23, 2025
Accepted: February 4, 2026
Published online: April 18, 2026
Processing time: 164 Days and 18 Hours
Proximal tibial fractures (PTFs), including tibial plateau fractures (TPFs), are usually managed with osteosynthesis; however, in elderly patients with pre-injury knee osteoarthritis and osteoporotic bone, performing an acute total knee arthroplasty (aTKA) became a viable management option.
To explore the indications, patient characteristics, implant selection, and reported outcomes (functional, radiological, complications, and revision rates) after aTKA to manage traumatic PTFs.
A systematic literature search of English-language studies reporting on the aTKA for managing PTFs, including TPFs, was conducted across three major databases (EMBASE, PubMed, and Scopus) from inception to December 2024.
Of the 1055 reviewed articles, 14 studies with 174 patients met the inclusion criteria. The mean age was 71.3 years, and 60.9% were females. The incidence of pre-injury knee osteoarthritis ranged from 22.7% to 100%, and 90.8% were TPFs. A medial parapatellar approach was used in all cases, and a posterior-stabilized implant was most commonly used (49.4%). Of 103 patients in whom extras were used, 97.1% had a tibial stem, and 20.4% required metal augments for tibial bone defect reconstruction. After a mean follow up of 28.5 months, the maximum knee flexion as reported from 121 patients had a mean of 110.3 degrees, while the functional outcomes per the Knee Society Function and Knee Scores were reported in 129 patients and had good and fair outcomes, respectively. Complication incidence was 16.67%, with infection as the most common complication, and revision was required in only 3 (2.3%) patients.
The aTKA for managing PTFs is an appealing management option with acceptable functional, complication, and revision outcomes. Various implants and extras can be employed based on fracture type, collateral ligament status, and bone defect size. Better-designed studies with a larger number of patients and longer follow up are needed to validate the outcomes of such a management approach compared to other management options.
Core Tip: Managing proximal tibial fractures, particularly tibial plateau fractures, in elderly patients with osteoporotic bone and pre-existing knee osteoarthritis is challenging. This systematic review evaluated the role of acute total knee arthroplasty as a primary treatment option. Fourteen studies involving 174 patients were analyzed. Most were elderly females with total knee arthroplasty and pre-injury osteoarthritis. Posterior-stabilized implants were commonly used, often with tibial stems and metal augments. Outcomes were favorable, with a mean flexion of 110 degrees and generally good Knee Society Scores. Complications occurred in 16.7%, and revisions in 2.3%. Despite promising results, evidence quality was low, warranting larger comparative studies.