Managing Post-Traumatic Arthritis of the Knee with Total Knee Arthroplasty

PTA may be related to periarticular fracture, ligamentous injury, or malalignment from extra- articular fractures causing non-physiologic wear of the articular surface. Once injury occurs, arthritic degeneration occurs rapidly, with bony injuries being 2-fold more likely to result in needing a TKA than soft tissue injuries about the knee. PTA tends to present itself in patients who are young, man, and who tend to be healthier. These patients also present with greater disability and pain relative to patients with primary osteoarthritisOA. The challenges faced by the surgeon in restoring a well-functioning, stable and balanced joint are varied. Because no 2 cases of PTA are the same, thoughtful and thorough planning is crucial to the success of the surgery. Preoperative planning with a detailed history, complete examination, and full limb imaging allows the surgeon to not only optimize the patient, but also better understand how the injury and the subsequent treatments have affected the limb. The intra-operative challenges faced include gaining adequate exposure, managing retained implants, addressing bone loss and soft tissue incompetence, and correcting any malalignment caused by the injury and joint degeneration. Using an algorithmic approach at each step of the case will allow the surgeon to gain adequate exposure, reestablish the joint line, address any bony, or ligamentous concerns in order to provide a well-functioning implant. The current literature indicates that these patients are at a higher risk of complication, revision, and reduced implant survivorship. However, these patients have similar rates of improvement in their pain, function, and range of motion when compared with patients undergoing TKA for primary OA, making this a viable and successful option for an otherwise difficult problem.