Total knee arthroplasty with metaphyseal sleeves for acute tibial plateau fractures

Aims: Total knee arthroplasty (TKA) allows immediate weightbearing and avoids challenges associated with secondary arthroplasty following conservative management or failed fixation of tibial plateau fractures (TPFs). Metaphyseal sleeves may overcome the limitations of conventional implants by addressing issues of deficient bone stock and inadequate proximal fixation in the fracture zone. Methods: We conducted a retrospective case series of patients undergoing TKA with metaphyseal sleeves for acute TPFs at a single tertiary centre between January 2019 and June 2025. Demographic details, injury characteristics, clinical outcomes, and complications were extracted from electronic records. Results: A total of 16 patients were included (mean age 73.8 years (SD 6.0), 93.8% female). Of these patients (87.5% (n = 14/16) were osteoporotic, and 37.5% (n = 6/16) had pre-existing osteoarthritis. The median follow-up was 12 months (IQR 3 to 72). Immediate weightbearing was achieved in all. Radiographs in all patients showed metaphyseal sleeve integration and no subsidence by three months. One patient was followed up at six years showing no adverse radiological signs. Mean knee range of motion improved from 90.7° at sixweeks to 108.1° at final follow-up. Complications occurred in 25.0% of patients (n = 4/16), most commonly wound-related (n = 2/16). Two patients (12.5%) required further surgical intervention. Conclusion: TKA with metaphyseal sleeves has a role in selected elderly patients with TPF not amenable to reconstruction. It addresses fixation failure in TPF and enables early mobilization with acceptable outcomes. Cite this article: Bone Jt Open 2026;7(4):557–565.