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Patients undergoing total knee arthroplasty after tibial plateau fracture show functional improvement similar to primary arthroplasty patients: Propensity-matched cohort analysis
, Perry L. Limb,c, Robert K. Wagnera,b, Karim Soroura, Hany S. Bedairb,c, Christopher M. Melnicb,c, Thuan V. Lya,b, John G. Espositoa,b
⁎Corresponding author: Jacob S. Borgida. jborgida@bwh.harvard.edu
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Received: ,
Accepted: ,
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Patients with a previous tibial plateau fracture (post-TPF) may be susceptible to worse outcomes after total knee arthroplasty (TKA) than patients undergoing primary TKA (pTKA). However, there is limited comparative evidence on patient-reported outcomes (PROMs) of these cohorts. This study aimed to compare PROMs and rate of achieving Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) between post-TPF TKA and pTKA patients.
Thirty-three post-TPF TKA patients were identified from an institutional database between 2016 and 2023 and 1:3 propensity score matched to 97 pTKA patients treated in the same period. Outcomes included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Mental and Physical, PROMIS Physical Function short form 10a (PF SF 10a), and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) scores.
Post-TPF TKA patients had significantly lower preoperative scores on PROMIS Global Health Mental (47.8 vs. 51.4, P = .042) and PF SF 10a (35.5 vs. 37.5, P = .037) compared to pTKA patients. The absolute increase across all PROMs between the cohorts was similar, however, post-TPF TKA patients had a higher rate of achieving MCID-I for PROMIS Global Health Mental and PF SF 10a. Post-TPF TKA patients had a higher rate of 90-day complications (15 vs. 4%, P = .031).
Post-TPF TKA patients reached higher MCID-I rates in two PROMs, but had significantly higher complication rates compared to pTKA. Despite the risks, post-TPF TKA patients can achieve similar or better improvements, urging further research into long-term outcomes for effective patient counseling and shared decision-making.
Keywords
Total knee arthroplasty
Tibial plateau fracture
Patient-reported outcomes
Minimal clinically important difference
Complications
1 Introduction
Tibial plateau fractures (TPF) have an estimated incidence of 10.3 per 100,000 persons each year.1,2 The most prevalent long-term complication of TPFs is post-traumatic osteoarthritis due to degenerative changes caused by trauma and malalignment 3–5. To address the damage to the articular surfaces, total knee arthroplasty (TKA) is commonly performed to improve function and reduce pain.6 Patients with a prior TPF have a 3.5-5 fold increased rate of TKA 7–9. Total knee arthroplasty procedures in patients with a previous TPF can be more complex due to soft tissue scarring, prior incision(s), pre-existing hardware, and compromised bone stock.10,11 These patients may therefore be susceptible to worse outcomes and complication profiles than patients undergoing primary TKA (pTKA).12
Despite the high rate of TKAs performed each year, there are few studies comparing outcomes between these cohorts, which limits adequately informed shared decision making processes 13–17. To guide shared decision making processes and evaluate outcomes of arthroplasty surgery beyond conventional surgical outcomes (e.g., alignment, revision), patient-reported outcomes (PROMs) have become crucial.18,19 Specifically, the Patient-Reported Outcomes Measurement Information System (PROMIS) surveys have excellent reliability, minimal response burden, and evaluate a range of domains including mental and general health.19,20
To interpret PROMs, the minimal clinically important difference for improvement (MCID-I) and worsening (MCID-W) are frequently used to determine success or failure for a procedure 21–23. These thresholds can be used by surgeons to effectively guide patients’ expectations post-surgery. Therefore, the primary aims of this study were to compare preoperative and postoperative PROMs between post-TPF TKA and pTKA patients, and to compare rates of exceeding the threshold of MCID-I and MCID-W between both cohorts.
2 Methods
2.1 Patient selection
After institutional review board approval, post-TPF TKA patients were retrospectively identified from a prospectively maintained institutional database of two academic medical centers and four community hospitals within a single health care system from January 2016 to April 2023. Patients were identified using Current Procedural Terminology (CPT) code 27447 for TKA and International Classification of Diseases, Tenth Revision (ICD-10) codes S82.14, S82.12, S82.13 for bicondylar, lateral, or medial condyle tibial plateau fractures, respectively. Eligibility of patients was confirmed through chart review and the final post-TPF TKA cohort included 33 patients. To reduce the effect of confounding between the post-TPF TKA and pTKA groups, patients were matched using propensity scores. Propensity score matching using a three-to-one nearest-neighbor matching without replacement and a caliper fixed at .3 was conducted. The propensity scores were calculated including the following variables: age, sex, Body Mass Index (BMI), and Charlson Comorbidity Index (CCI).
2.2 Outcome variables
Demographic, surgical outcome variables, and PROMs were extracted from a prospectively maintained institutional database. Demographic variables included age, sex, BMI, CCI, and length of stay. Other surgical variables collected included initial management of the TPF, secondary implant handling (including staged or concurrent implant removal), and case duration of the TKA. Additionally, TKA components including cement, cone, stem, augment, and constrained polyethylene liners were collected. Postoperative outcomes included 90-day emergency department visits, 90-day readmissions, 90-day complications, all-cause reoperations, and revision surgeries (instability). Complications that were recorded comprised stiffness requiring reoperation (manipulation under anesthesia and arthroscopic lysis), periprosthetic joint infection (PJI), and systemic complications (swelling and pain). Patients with TPFs managed operatively or nonoperatively who then underwent TKA at one of the included institutions and had an available preoperative and postoperative PROM score for the same measure were included. Patients with less than 6 months follow-up were excluded. After applying inclusion and exclusion criteria, 33 post-TPF TKA patients were identified. Of these patients, 5 underwent removal of hardware and TKA at one of the included institutions following initial operative management of the TPF at an outside hospital.
Patient-reported outcome measures included the PROMIS Scale v1.2 Global Health Mental and Physical, the PROMIS Short Form v2.0 Physical Function 10a (PF SF 10a), and the Knee Disability and Osteoarthritis Outcome Score Physical Function Shortform (KOOS-PS).15 The PROMIS Global Physical, PROMIS Global Mental, PROMIS PF SF 10a, and KOOS-PS scores were manually extracted from the patient's electronic medical record. Preoperative PROMs were used for analysis when collected within six months before the index procedure, and postoperative scores were used when collected between 6 months and 2.5 years after the index procedure 23–25. For patients that completed multiple preoperative surveys, the score collected closest to the date of surgery was used. In the case of multiple post-operative scores in the established timeframe, the score closest to the one-year mark was used. The comparative PROMs analysis included all patients with paired preoperative and postoperative scores (i.e., availability of the same outcome score).
In accordance with Humphrey et al., the study established the MCID-I threshold as half the standard deviation of the mean change in PROMs for patients showing improvement post-surgery.22 Similarly, the MCID-W threshold was defined as half the standard deviation of the mean change in PROMs for patients experiencing a decline in scores after surgery. The anchor-based values from this previous study were used to determine MCID-I and MCID-W thresholds. These thresholds are based on prior studies within the same institution that involve over 2000 patients.23 Patients were classified as achieving MCID-I if an improvement of PROM scores was equal to or higher than the MCID-I threshold, and classified as MCID-W if a decline in PROM scores more than the MCID-W threshold. If scores fell between these thresholds the outcome was categorized as “No Change.” The anchor-based values for MCID-W and MCID-I in this study were derived from Salimy et al..23 The specific MCID-I and MCID-W thresholds for each of the four PROMs were as follows: KOOS-PS (+6.77 and −4.37), PROMIS PF SF 10a (+2.88 and −1.77), PROMIS Global Mental (+2.21 and −2.01), and PROMIS Global Physical (+2.84 and −1.81).
2.3 Statistical analysis
Descriptive statistics are reported as means with standard deviation (SD) for continuous and as frequencies with percentages for categorical variables. In bivariate analysis, categorical variables were compared using chi-squared test and continuous variables were compared using unpaired t-test. The change in PROM assessments from preoperative to postoperative was calculated for individual patients to ascertain MCID achievement. Statistical significance was established at P < .05. All statistical analysis were performed using R Studio (version 4.3.1, Vienna, Austria).
3 Results
3.1 Patient characteristics
A total of 33 post-TPF TKAs and 97 matched pTKAs were analyzed (Table 1). There were 2 Schatzker 1, 12 Schatzker 2, 6 Schatzker 4, 1 Schatzker 5, and 5 Schatzker 6 TPFs.26 Seven patients did not have injury films available, however, 2 patients were noted to have lateral TPFs, 2 had bicondylar TPFs, and 3 had medial TPFs confirmed by electronic health record chart review. The mean time from fracture to TKA was 38.3 months ± 43.3. Cones and stems were used significantly more for the TKAs in the post-TPF TKA cohort (9.1 vs .0%, P = .020; 48.4 vs. 11.3%, P < .001). Patients in the post-TPF TKA cohort had a significantly longer operative time (143.0 min ± 58.0 vs. 79.3 min ± 21.8, P = <.001) compared to pTKA patients. Of the 33 post-TPF TKA patients, 18 (54%) of the TPFs were initially managed operatively and 15 (46%) nonoperatively. Within the 18 operatively treated patients, 9 (50%) underwent concurrent hardware removal, and 9 (50%) had staged hardware removal. In 12 (67%) cases all hardware was removed and in 14 (78%) cases a single incision was used. The mean duration of staged treatment was 32.3 months ± 79.5. Subanalysis demonstrated no differences in PROMs between staged and concurrent cohorts. The mean postoperative clinical follow-up was 52.3 months ± 25.7 and 43.0 ± 19.0 (P = .030) for post-TPF TKA and pTKA patients, respectively. However, there was no difference between the two cohorts in regard to when the postoperative PROMs were collected between 6 months and 2.5 years after the index procedure.
| Variable | Total (N = 130) | Post-TPF TKA (N = 33) | TKA (N = 97) | P-value |
| Age (years) | 64.0 ± 10.4 | 63.9 ± 12.2 | 64.0 ± 9.8 | .947 |
| Sex | ||||
| Female | 76 (58.5%) | 18 (54.5%) | 58 (59.8%) | .746 |
| Male | 54 (41.5%) | 15 (45.5%) | 39 (40.2%) | |
| Charlson Comorbidity Index | 1.2 ± 1.8 | 1.1 ± 2.1 | 1.3 ± 1.6 | .563 |
| Body Mass Index (kg/m2) | 30.2 ± 6.0 | 29.9 ± 6.2 | 30.4 ± 6.0 | .692 |
| TKA Components | ||||
| Cement | 122 (93.8%) | 29 (87.9%) | 93 (95.9%) | .218 |
| Cone | 3 (2.3%) | 3 (9.1%) | 0 (.0%) | .020 |
| Stem | 27 (20.8%) | 16 (48.5%) | 11 (11.3%) | <.001 |
| Augment | 1 (.8%) | 1 (3.0%) | 0 (.0%) | .570 |
| Constrained polyethylene | 4 (3.1%) | 2 (6.1%) | 2 (2.1%) | .572 |
| Operative Time (minutes) | 95.5 ± 44.6 | 143.0 ± 58.0 | 79.3 ± 21.8 | <.001 |
3.2 Patient-reported outcome measures
The post-TPF TKA patients had significantly lower preoperative scores for PROMIS Global Mental (47.8 vs. 51.4, P = .042) and PF SF 10a (35.5 vs. 37.5, P = .037) when compared with pTKA patients (Table 2). There were no differences in preoperative scores for the KOOS-PS and PROMIS Global Physical. The mean change for all PROMs when comparing preoperative to postoperative scores was similar between the two cohorts. Post-TPF TKA patients had a higher rate of achieving MCID-I for PROMIS Global Health Mental and PF SF 10a than pTKA patients, but the rates of achieving MCID-W were similar for all PROMs. There were no differences in postoperative scores for all PROMs.
| Variable | Post-TPF TKA (N = 33) | TKA (N = 97) | P-value |
| PROMIS Global – Physical | n = 31 | n = 97 | |
| Preop Score | 40.7 ± 7.7 | 42.7 ± 6.0 | .145 |
| Postop Score | 47.2 ± 9.8 | 46.4 ± 7.4 | .633 |
| Delta Score | 6.5 ± 7.4 | 3.8 ± 6.9 | .060 |
| MCID-I | 21 (67.7%) | 47 (48.5%) | .063 |
| No change | 6 (19.4%) | 34 (35.0%) | .100 |
| MCID-W | 4 (12.9%) | 16 (16.5%) | .632 |
| PROMIS Global – Mental | n = 31 | n = 97 | |
| Preop Score | 47.8 ± 9.3 | 51.4 ± 8.1 | .042 |
| Postop Score | 49.4 ± 9.6 | 51.4 ± 9.1 | .301 |
| Delta Score | 1.6 ± 6.4 | −.0 ± 7.4 | .281 |
| MCID-I | 21 (67.7%) | 44 (45.3%) | .030 |
| No change | 4 (12.9%) | 22 (22.7%) | .239 |
| MCID-W | 6 (19.4%) | 31 (32.0%) | .178 |
| PROMIS PF SF 10a | n = 28 | n = 93 | |
| Preop Score | 35.5 ± 4.8 | 37.5 ± 4.4 | .037 |
| Postop Score | 42.8 ± 6.7 | 43.4 ± 8.6 | .729 |
| Delta Score | 7.3 ± 5.5 | 5.9 ± 8.7 | .421 |
| MCID-I | 23 (82.1%) | 56 (60.2%) | .033 |
| No change | 4 (14.3%) | 21 (22.6%) | .342 |
| MCID-W | 1 (3.6%) | 16 (17.2%) | .069 |
| KOOS-PS | n = 20 | n = 91 | |
| Preop Score | 55.9 ± 12.2 | 55.3 ± 13.5 | .843 |
| Postop Score | 72.2 ± 12.7 | 70.1 ± 17.2 | .618 |
| Delta Score | 16.2 ± 12.4 | 15.3 ± 20.2 | .839 |
| MCID-I | 15 (75.0%) | 58 (63.7%) | .336 |
| No change | 5 (25.0%) | 19 (20.9%) | .685 |
| MCID-W | 0 (.0%) | 14 (15.4%) | .061 |
3.3 Postoperative complications
Patients in the post-TPF TKA cohort reported a significantly higher rate of 90-day postoperative complications (15 vs. 4%, P = .031) including PJI (n = 1), stiffness requiring reoperation (n = 3), and systemic complications (n = 1) (Table 3). The most common indication for reoperation in the post-TPF TKA cohort was stiffness (3 patients, 9.1%). All three patients were treated operatively for their TPFs; two underwent concurrent TKA and hardware removal, and one underwent staged hardware removal. The indication for reoperation was limited flexion in all 3 patients. Two patients had range of motion between 0 and 90° and one patient was limited to 0-45° prior to reoperation. No difference was observed between the post-TPF TKA and pTKA cohorts for 90-day ED visits, 90-day readmissions, all-cause revisions or reoperations.
| Variable | Post-TPF TKA (N = 33) | TKA (N = 97) | P-value |
| 90-day postoperative complications | 5 (15%) | 4 (4%) | .031 |
| 90-day ED visits | 2 (6%) | 4 (4%) | .647 |
| 90-day readmissions | 4 (12%) | 4 (4%) | .218 |
| Revisions | 2 (6%) | 2 (2%) | .251 |
| Reoperations | 5 (15%) | 6 (6%) | .110 |
4 Discussion
Patients sustaining TPFs may develop post-traumatic osteoarthritis due to articular damage and progressive narrowing of the joint space.3,5 Despite the high rate of knee arthroplasties performed annually, there is a paucity of evidence that compares outcomes between post-TPF TKA and pTKA patients, which limits adequately informed shared decision making processes 13–17. The present study found that post-TPF TKA patients reported significantly lower preoperative scores, but achieved higher rates of MCID-I for PROMIS Global Health Mental and PF SF 10a. Additionally, post-TPF TKA patients had a higher 90-day complication rate.
Few studies have assessed PROMs of post-TPF TKA patients with a matched cohort of pTKA patients and no studies to the authors knowledge have analyzed MCID achievement between these two groups.15,16 Scott et al. compared outcomes of 31 post-TPF TKA and 93 pTKA patients using the SF-12 Mental and Physical Components and the Oxford Knee Score (OKS).16 They found post-TPF TKA patients reported significantly lower preoperative scores on the Mental Component of the SF-12 form and the OKS.16 There was no difference in postoperative scores for any of the PROMs. This is similar to the findings of the present study, where post-TPF TKA patients had significantly lower preoperative PROMIS Global Health Mental and PF SF 10a scores, and no difference in postoperative scores for any of the PROMs. The lower preoperative scores may be attributed to the long-lasting effects of the initial injury such as residual stiffness, pain, and limited physical abilities, which all impact general health and extremity specific outcomes.27,28 However, the difference in preoperative scores was less than the standard deviation of 10 points for PROMIS surveys, which should be acknowledged when incorporating the results into clinical decision-making. Interestingly, Lizaur-Utrilla et al. did not find a difference in preoperative or postoperative PROMs scores between 29 post-TPF TKA and 58 pTKA patients, although there was a trend toward lower scores in the post-TPF TKA cohort.15
In the present study, both cohorts showed a positive change across all four PROMs. Patients in the post-TPF TKA cohort had lower preoperative scores on the PROMIS Global Health Mental and PF SF 10a, but achieved MCID-I at a higher rate than pTKA patients. This finding can be attributed to having more opportunity for improvement from baseline to postoperative assessment.29 Although the delta scores were similar between the two cohorts, the post-TPF TKA cohort trended towards higher delta scores. Future studies with more post-TPF TKA patients would allow for further analysis to determine the true impact of TKA for patients with a prior TPF. Thus, post-TPF TKA patients may be counseled that TKA offers improvement similar or even better to pTKA patients, although baseline scores may be lower. Interestingly, a proportion of patients in both cohorts declined beyond the threshold for MCID-W on the PROMIS Global Mental, PROMIS Global Physical, and PF SF 10a surveys. This result should be included in shared decision making processes with discussion of factors such as high presurgical BMI and contralateral knee pain, which have been shown to negatively impact outcomes after TKA.30,31
The PROMs used in this study have been validated and are based on large sample sizes. The KOOS-PS is a comprehensive anatomic location and disease-specific questionnaire, and one of the most frequently used PROMs in arthroplasty registries.32,33 The PROMIS Global Physical and PF SF 10a were shown to have a strong correlation to KOOS-PS and all are acceptable to measure function in patients with knee damage.34 Prior studies have not utilized PROMIS Global Health Physical and Mental surveys to evaluate outcomes in post-TPF TKA patients. These surveys provide valuable information on patient's general health and physical function, and are predictive of future health care utilization.35
The post-TPF TKA cohort demonstrated a significantly higher 90-day complication rate, similar to a previous study by Weiss et al. who reported a 26% postoperative complication rate in 62 post-TPF TKA patients.14 Similarly, Lizaur-Utrilla et al. found a higher complication rate in post-TPF TKA patients (14%) compared to pTKA patients (0%).15 The higher rate of complications in the post-TPF TKA patients has been previously attributed to factors such as soft-tissue compromise from previous surgery, prior incisions, ligamentous instability, and compromised bone stock.10,11 Cones and stems were used significantly more in the post-TPF TKA cohort, which may be due to larger bone defects in these patients.36,37 Further, the operative time was significantly longer for post-TPF TKA patients, which adds to existing evidence on the complexity of TKA after fracture compared to pTKA.38,39 The PJI rate in the post-TPF TKA cohort (1 patient, 3%) is lower than a previous study reporting PJI in 5 out of 21 patients (24%) undergoing conversion TKA after being operatively treated for a TPF.40 This result may be due to the inclusion of nonoperatively treated TPFs, as Scott et al. reported 1 (3.2%) deep infection in their cohort of 31 post-TPF TKAs, which were treated both operatively and nonoperatively.16 Future studies should aim to identify modifiable factors contributing to these high complication rates, specifically, relating to stiffness in post-TPF TKA patients as this was an indication for reoperation in 9% of the cohort. This is similar to the rate reported by Scott et al. in a cohort of 221 post-TPF TKA patients (5.9%).41
There are several limitations to this study. First, inherent to the retrospective nature of this series, there was no standardized treatment for TPFs and there was heterogeneity in the severity of fractures. However, comparing PROMs for post-TPF TKA patients with pTKA patients has not been studied in large cohorts and there remains limited prior studies.15,16 Second, the small sample size may impact the power of the results. Thus, definitive conclusions on the counseling and treatment of post-TPF TKA patients may not be made based on the results of the present study and further research is required to improve care for these patients. Third, the patients in the control cohort (pTKA) were not consecutive and were treated at the same two Level-1 trauma centers. To find well-matched comparisons most effectively, patients were matched in a three-to-one manner using a database of TKA patients that is prospectively maintained. Lastly, the database search may have missed patients treated for a TPF at our institution who underwent TKA at an outside hospital.
5 Conclusion
Using MCID, this study found that post-TPF TKA patients achieve higher MCID-I rates in certain PROMs but have a significantly higher rate of 90-day complications. The present study offers insights for setting expectations and understanding outcomes for individuals with a previous TPF undergoing arthroplasty, highlighting the need for further research on long-term effectiveness.
Author contributions
JSB: Conceptualization, data curation, methodology, writing – original draft and review & editing.
PLL: Conceptualization, data curation, methodology, writing – original draft and review & editing.
RKW: Conceptualization, methodology, writing – original draft and review & editing.
KS: Data curation, project administration, writing – original draft and review & editing.
HSB: Methodology, supervision, writing – review & editing.
CMM: Methodology, data curation, supervision, writing – review & editing.
TVL: Methodology, data curation, supervision, writing – review & editing.
JGE: Conceptualization, methodology, supervision, writing – review & editing.
Institutional review board approval
Massachusetts General Hospital Protocol #2022P000471.
Institutional Review Board approval was obtained prior to starting study-related procedures.
Guardian consent J orthop
The IRB has determined that this project meets the criteria for exemption 45 CFR 46.104(d)(#).
EXEMPTION (4) Secondary research for which consent is not required: Secondary research uses of identifiable private information or identifiable biospecimens, if at least ONE of the following criteria is met:(iii)The research involves only information collection and analysis involving the investigator's use of identifiable health information when that use is regulated under 45 CFR parts 160 and 164, subparts A and E, for the purposes of “health care operations” or “research” as those terms are defined As Principal Investigator, you are responsible for the following:1.Ensuring that this project is conducted in compliance with the exemption determination.2.Ensuring that all study staff have completed the required human research education requirements through the Collaborative Institutional Training Initiative (CITI).3.Submission of significant proposed changes to this project to ensure that the project continues to meet the criteria for exemption.4.Submission of Exempt Check-In as required by institutional policy.
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
References
- Population-based epidemiology of tibial plateau fractures. Orthopedics. 2015;38(9):e780-e786.
- [Google Scholar]
- Endstage arthritis following tibia plateau fractures: average 10-year follow-up. Can J Surg. 2012;55(2):87-94.
- [Google Scholar]
- Total knee arthroplasty and fractures of the tibial plateau. World J Orthoped. 2017;8(2):107-114.
- [Google Scholar]
- Degenerative arthritis after tibial plateau fractures. J Orthop Trauma. 1995;9(4):273-277.
- [Google Scholar]
- A randomized, controlled trial of total knee replacement. N Engl J Med. 2015;373(17):1597-1606.
- [Google Scholar]
- Risk of total knee arthroplasty after operatively treated tibial plateau fracture: a matched-population-based cohort study. J Bone Joint Surg Am. 2014;96(2):144-150.
- [Google Scholar]
- Risk for total knee arthroplasty after tibial plateau fractures: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2023;31(11):5145-5153.
- [Google Scholar]
- Tibial plateau fractures are associated with a long-lasting increased risk of total knee arthroplasty a matched cohort study of 7,950 tibial plateau fractures. Osteoarthr Cartil. 2019;27(5):805-809.
- [Google Scholar]
- Radiographic predictors of conversion to total knee arthroplasty after tibial Plateau fracture surgery: results in a large multicenter cohort. J Bone Joint Surg Am. 2023;105(16):1237-1245.
- [Google Scholar]
- Total knee arthroplasty in patients with prior femoral and tibial fractures: outcomes and risk factors for surgical site complications and reoperations. Orthop Surg. 2020;12(1):210-217.
- [Google Scholar]
- The predictors of outcome in total knee arthroplasty for post-traumatic arthritis. Knee. 2013;20(6):432-436.
- [Google Scholar]
- Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau: a minimum five-year follow-up study. J Bone Joint Surg Am. 2001;83(8):1144-1148.
- [Google Scholar]
- Total knee arthroplasty in patients with a prior fracture of the tibial plateau. J Bone Joint Surg Am. 2003;85(2):218-221.
- [Google Scholar]
- Total knee arthroplasty for osteoarthritis secondary to fracture of the tibial Plateau. A prospective matched cohort study. J Arthroplast. 2015;30(8):1328-1332.
- [Google Scholar]
- Total knee arthroplasty following tibial plateau fracture: a matched cohort study. Bone Jt J. 2015;97-B(4):532-538.
- [Google Scholar]
- Total knee arthroplasty in patients with a prior tibial Plateau fracture: a long-term report at 15 years. J Arthroplast. 2015;30(12):2170-2172.
- [Google Scholar]
- Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998;80(8):1132-1145.
- [Google Scholar]
- Patient-reported outcome measurement in orthopaedic trauma. J Am Acad Orthop Surg. 2023;31(20):e906-e919.
- [Google Scholar]
- Patient-Reported Outcome Measurement Information System (PROMIS) in orthopaedic trauma research. SICOT J. 2021;7:39.
- [Google Scholar]
- How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcome. 2020;18(1):136.
- [Google Scholar]
- Defining failure in primary total joint arthroplasty: the minimal clinically important difference for worsening score. J Arthroplast. 2022;37(4):630-636.e1.
- [Google Scholar]
- Patients consistently report worse outcomes following revision total knee arthroplasty compared to primary total knee arthroplasty. J Arthroplast (23):S0883-S5403.
- [Google Scholar]
- A matched comparison of the rates of achieving the minimal clinically important difference following conversion and primary total hip arthroplasty. J Arthroplast. 2023;38(9):1767-1772.
- [Google Scholar]
- The recovery curve for the patient-reported outcomes measurement information system patient-reported physical function and pain interference computerized adaptive tests after primary total knee arthroplasty. J Arthroplast. 2018;33(8):2471-2474.
- [Google Scholar]
- Revisiting the management of tibial plateau fractures. Injury. 2022;53(6):2207-2218.
- [Google Scholar]
- The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty. Rheumatol Int. 2020;40(12):1961-1986.
- [Google Scholar]
- Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res. 2013;6:691-703.
- [Google Scholar]
- Outcomes of lateral unicompartmental knee arthroplasty in post-traumatic osteoarthritis, a retrospective comparative study. Int Orthop. 2020;44(11):2321-2328.
- [Google Scholar]
- Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery. BMC Muscoskelet Disord. 2014;15(1):299.
- [Google Scholar]
- Factors correlated with physical function 1 year after total knee arthroplasty in patients with knee osteoarthritis: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(7)
- [Google Scholar]
- Collection and reporting of patient-reported outcome measures in arthroplasty registries: multinational survey and recommendations. Clin Orthop Relat Res. 2021;479(10):2151-2166.
- [Google Scholar]
- Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcome. 2003;1:17.
- [Google Scholar]
- Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009;18(7):873-880.
- [Google Scholar]
- The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Jt J. 2016;98-B(1 Suppl A):120-124.
- [Google Scholar]
- Bone loss in revision total knee arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2017;25(5):348-357.
- [Google Scholar]
- Conversion total knee arthroplasty: a case complexity between primary and revision total knee arthroplasty. Knee. 2021;31:180-187.
- [Google Scholar]
- Risk factors for wound complications following conversion TKA after tibial Plateau fracture. Indian J Orthop. 2022;56(10):1751-1758.
- [Google Scholar]
- Primary versus secondary total knee arthroplasty for tibial Plateau fractures in patients aged 55 or Over-A systematic review and meta-analysis. J Arthroplast. 2024;39(2):559-567.
- [Google Scholar]