shattered tibial plateau

[DogLover]

I fell down stairs and broke both my tibial plateau's. The one I shattered, the other was a clean break, in fact at first they missed it. I was off both legs, surgery on the shattered leg, resulted in a plate and 5 screws. This was Feb 26, 2012. Surgery March 2, 2012. Two weeks in hospital, home care 2 months, physical therapy till I ran out of money literally even with insurance. My problem is I have been told the leg is not good, it did not work. It was shattered in 7 pieces and they did not go back together well. He says it is now "crushing" the bone around the screws. Has anyone heard of this? I am very discouraged as I went through so much and almost a year later, he is talking that I need a knee replacement. I wonder if that should have been done in the beginning, OR, do they ever do that? I progressed from the wheelchair to the walker when I could weight bare on my good leg. Then I even progressed to a cane, but now we are going backwards. The leg is worse, I can hardly walk on it. My tolerance of pain is very high and this is bringing me to tears. Nothing helps, ice or the vicodin. I am not sure what to think. I am 58 years old and pretty active, or was. Has anyone had to go back and get a knee after the original surgery? Does a knee relacement take care of all parts of the tibia plateau as well? I feel like I am starting over.

[peaton]

I spoke with my surgeon about this before my surgery doing a knee replacement. He told me that the joint would have to heal so that he had something to attach the artificial parts to. Now that you have the plate and screws in there they will have to be removed and then time for the bone to heal. Good luck.

[Orthoski]

DogLover...so sorry to hear about your experiences. Needless to say, we all feel for you in what must have been an extremely challenging year.

As peaton alread mentioned, you would never do a knee replacement immediately for a tibial plateau (except in extremely rare cases in which case you can't even do a standard knee replacemen). The two main reasons are that, 1) in an active 58-year-old, you want to give the patient a chance to heal, and 2) you need solid bone to attach the tibial (shin bone) component of the total knee, which you can't do if the bone's shattered. If anyone told you they got a hip replacement after a hip fracture (femoral neck), this is different for anatomic reasons and doesn't apply to knees. While, as a surgeon, you do all you can when fixing the shattered pieces (get them aligned as well as you can and sometimes even put bone cement to buttress the pieces up), sometimes this repair still falls apart and, as the patient weight bears, it pushes the bone down exposing the screws into the joint. A knee replacement will replace the joint surface in both the tibia and femur (thigh bone), but if that's the path you're on, you'd want someone who does revision knees (i.e., re-doing a knee that has already been replaced previously) in his/her practice because yours will not be as straight-forward as a regular knee replacement. If a lot of bone is squashed down in your tibial plateau, it needs to somehow be filled in to support the tibial part of the knee replacement, often with modular metal components called "augments."

I know it feels like starting all over, and in some ways it is, but you would have never wanted someone to do a knee replacement without giving you a chance to heal - this is the price you had to pay to be able to justify this next step. Best of luck, stay strong as you have been, and keep us posted.

[peaton]

Well it has been a while since I have been on here, I suppose that is a good thing. Here is a recap of what and when:

Date of Injury 5/23/12
Date of Surgery 5/30/12
Nondisplaced Fx Of The Patella
2 - Fx's Tibial Shaft
Comminuted 1" Depression Fx of Laterial Plateau Articular Surface
Large Linear Longitudinal Fx Line Distally
8mm Approx. Displaced In The Joint Space Lateral To The Intercondylar notch
Longitudinal Fx Through The Medial Tibial Plateau

I started partial weight bearing on Sept. 4th 2012. It is now 3 yrs since the damage was done. I can't begin to tell you how I'd love to have that day back if I could, for this to never have happened, not to be though. I did have a bone scan to make sure they were OK, and all was good there. Just a freak thing. Everything was good in 2014. Only had a little stiffness and swelling with overuse, but I have cut way back on my strenuous activities. As of last week all has gone to hell. I have been having problems with knee pain, giving out of the knee, feeling/sensation of bone-on-bone sensation that just sends jolting pain up/down the leg. Has been progressively getting worse. Afraid to call my OS and make an appointment.

[regct]

There is a HUGE thread on tp fx in here. Probably some good advice in there.