Total knee arthroplasty in patients with severe obesity:outcomes of standard keeled tibial components versus stemmed universal base plates

Background: Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m2] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m2: standard keeled (SK) or universal base plate (UBP), which incorporates a stem. Methods: This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m2: mean age 62.2 ± 8.0 (44–87) years, mean BMI 44.3 ± 4.6 (40–65.7) kg/m2 and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively. Results: Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan–Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4–100 95% confidence interval (CI)] and UBP 100% (p = 0.391). Overall varus alignment of the limb (p = 0.005) or the tibial component (p = 0.031) was significantly associated with revision and return to theatre. Conclusions: At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m2. Varus alignment of either tibial component or the limb was associated with revision and return to theatre.</p

Acute Total Knee Arthroplasty for Unicondylar Tibial Plateau Fracture Using Metaphyseal Cones

Tibial plateau fractures (TPFs) in older adults are increasing in incidence and now account for 8% of all fractures in patients over 60 years of age. Although primary fixation remains standard, the risk of fixation failure, loss of reduction, and the development of posttraumatic osteoarthritis are all markedly increased in this age group with higher rates of conversion to total knee arthroplasty (TKA) of 12%. When joint depression is severe with significant subchondral bone loss, up to half ultimately require TKA. TPFs with unicondylar depression can be managed primarily using tibial cones in acute TKA. In this study, we report the surgical technique for performing acute TKA using tibial cones for the primary management of TPFs in older adults and illustrate this technique with case examples