Introduction: Tibial plateau fractures are routinely treated with open reduction internal fixation (ORIF); however, the long-term results of ORIF are unclear. The purpose of the current study is to evaluate outcomes in these patients, including: the rate of conversion of ORIF to total knee arthroplasty (TKA), the relationship between elevated inflammatory markers after the initial ORIF and subsequent infection in TKA, and the rationale behind performing the conversion to TKA in one step versus two steps. Methods: Using current procedural terminology (CPT) codes, we assembled a cohort of 891 patients (933 knees) who underwent ORIF for a tibial plateau fracture from 2007 to 2017 at the investigating institution. The patients were then reviewed for pertinent demographic information and for the outcomes of interest. Results: Of the 933 knees, a total of 20 knees (2.15%) required conversion from ORIF to TKA. Of the 20 knees that underwent conversion to TKA, three were performed as a two-stage conversion. Of the 20 knees that underwent TKA, seven experienced postoperative arthrofibrosis, four experienced postoperative infection, and four required revision. Conclusion: Our retrospective study suggests that the need for conversion to TKA is uncommon following ORIF of a tibial plateau fracture. Furthermore, the conversion to TKA can be performed as a one- or two-stage procedure, and based on our study, we suggest that there may be higher rates of infection with the single stage conversion. Level of evidence: Level III, Retrospective study.