OTSR - 2026-03-18 - Journal Article
Septic tibial plateau nonunion leads to poor outcomes and frequent salvage procedures: A long-term cohort study.
Spiridon M, Rougereau G, Ménigaux C, Hardy A, Bauer T, Pioger C
Topics
Key Takeaway
Septic tibial plateau nonunion required salvage procedures in 82% of patients (23/28), with only 18% achieving union and infection remission without major intervention at mean 8.1-year follow-up.
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Summary
This retrospective cohort from a national FRI referral centre (CRIOAC) evaluated long-term outcomes in 28 adults with septic tibial plateau nonunion treated between 2002–2023. Salvage procedures were required in 82%: TKA in 50%, transfemoral amputation in 18%, and femorotibial arthrodesis in 14%. Among patients retaining a mobile joint, functional scores remained poor (KSS 46.1 ± 12.2, KOOS 41.4 ± 9.6), and persistent infection was present in 21% at final follow-up.
Key Limitation
The 21-year inclusion window spans substantial evolution in FRI management protocols, implant technology, and antibiotic strategies, making the cohort internally heterogeneous and potentially overstating current failure rates.
Original Abstract
BACKGROUND
Septic nonunion of tibial plateau fractures is an exceptionally rare and severe complication for which long-term outcomes and the need for definitive salvage procedures are poorly documented. The juxta-articular location, limited bone stock, and frequent soft-tissue compromise make management particularly challenging, even in specialised centres.
HYPOTHESIS
It was hypothesised that most patients with septic nonunion of the tibial plateau ultimately require non-reconstructive salvage procedures and experience poor long-term functional outcomes.
METHODS
A retrospective cohort study was conducted at a national referral centre for complex osteoarticular infections (CRIOAC). All adults treated for septic nonunion of the tibial plateau between 2002 and 2023 were included, with a minimum follow-up of two years. Septic nonunion was defined by absent healing after ≥6 months combined with microbiologically confirmed deep infection according to Fracture-Related Infection (FRI) criteria. Demographic data, fracture characteristics, microbiology, surgical management, and long-term outcomes were collected. The primary outcome was the rate and type of non-reconstructive salvage procedures (arthrodesis, transfemoral amputation, or delayed total knee arthroplasty). Functional outcomes (KSS, KOOS, VAS, range of motion) were assessed when applicable.
RESULTS
Twenty-eight patients were included (mean age 45 ± 15 years; mean follow-up 8.1 ± 6.3 years). Only 5 of 28 patients (18%) achieved both union and infection remission without salvage surgery. Salvage procedures were required in 23 of 28 patients (82%), including total knee arthroplasty in 14 (50%), femorotibial arthrodesis in 4 (14%), and transfemoral amputation in 5 (18%). Persistent infection at final follow-up was recorded in 6 of 28 patients (21%). Functional outcomes were generally poor, with KSS 46.1 ± 12.2 and KOOS 41.4 ± 9.6 among patients retaining a mobile joint. Numerical trends suggested that diabetes, immunosuppression, open fractures, and polymicrobial infection may be associated with failure.
CONCLUSION
Septic nonunion of the tibial plateau is associated with extremely limited reconstructive potential and a high likelihood of salvage procedures, even within a specialised multidisciplinary centre. These results provide essential data for prognosis assessment and transparent patient counselling in this complex clinical scenario.
LEVEL OF EVIDENCE
IV; retrospective cohort study.