Abstract
ObjectiveKnee arthritis associated with tibial stress fractures represents an uncommon and difficult clinical scenario to treat. The use of long, fluted tibial extension rods has been vital in the management of such cases owing to immediate fracture stability and single-stage surgery without the need to open the fracture site. This study investigates clinical and radiological outcomes following total knee arthroplasty using a tibial extension stem in cases of knee osteoarthritis with tibial stress fracture.MethodsFrom February 2015 to December 2020, 17 patients who had total knee arthroplasty implanted with a long stemmed tibial component were included in the study. Patient data were analyzed for knee range of motion, deformities, Knee Society score, knee function score, and time to fracture union in the pre- and postoperative periods.ResultsThe mean follow-up duration was 22.7 ± 11.68 months (range 12–60 months), and mean time to fracture healing was 10.23 ± 2.81 weeks (range 8–20 weeks). The preoperative mean fixed flexion deformity improved from 8.53 ± 3.43° to a mean of 0.29°, and knee flexion improved from 79.4 ± 13.90° to 125.29 ± 8.74° on postoperative assessment. The Knee Society score improved from a mean preoperative score of 18.94 ± 5.55 (range 8–28) to 89.41 ± 7.5 (range 74–102, p value < 0.001). Similarly, the knee function score improved significantly from a mean preoperative score of 15.5 ± 4.48 (range 8–26) to a mean of 85 ± 6.09 (range 72–94, p value < 0.001).ConclusionTotal knee arthroplasty using long tibial extenders has been an effective and safe surgical option for patients with advanced osteoarthritis with tibial stress fractures.
Highlights
Stress fracture is a failure of bony architecture to withstand repetitive, subthreshold stress, leading to partial or complete fracture that is not associated with anyReddy et al Knee Surgery & Related Research (2022) 34:7 osteomalacia, Paget’s disease, hyperparathyroidism, rheumatoid arthritis, and metabolic bone disease [1, 2].Stress fracture elsewhere in the body are usually treated by rest, casting, and sometime surgery with internal fixation [1,2,3]
We describe an observational study of a series of 17 cases with end-stage knee arthritis associated with stress fractures of the proximal third of tibia treated with simultaneous total knee arthroplasty using long, fluted stemmed tibial components to ensure rotational stability distal to the fracture site
Study population and data collection Patients with end-stage degenerative knee arthritis associated with stress fracture of the proximal third of the tibia treated at our institute from February 2015 to December 2020 were analyzed
Summary
Stress fracture elsewhere in the body are usually treated by rest, casting, and sometime surgery with internal fixation [1,2,3]. Stress fracture of proximal tibia in the setting of end-stage severe arthritis of the knee, occur secondary to severe malalignment in the coronal plane, leading to a concentration of stresses on the medial/lateral side of proximal tibia in varus/valgus knee [4, 5]. The stress concentration leads to partial or complete fracture of the bone at point of fatigue. This scenario presents a complex clinical condition to treat because of poor bone quality, elderly patient population, obesity, preexisting rheumatoid arthritis or steroid treatment, abnormal metabolic profile, and limited available evidence regarding the effectiveness of available treatment options. Historic treatment options include nonoperative treatment in a cast, while operative treatment includes two stage surgery with internal fixation with or without osteotomy in the first stage and total knee arthroplasty (TKA) in the second stage, simultaneous total knee arthroplasty and internal fixation in one sitting, and simultaneous total knee arthroplasty with fracture fixation using tibial stem extensions [6, 7]
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