Proximal tibia stress fractures with Grade 4 Osteoarthritis of Knee-Experience with long stem TKR

Abstract

Introduction: Osteoarthritis of the Knee with Tibial stress fracture is not so common entity. It poses additional challenges for doing Total Knee Arthroplasty. We studied the radiological and functional outcome of Single-stage total knee arthroplasty with long stem components for patients with grade 4 of knee osteoarthritis and proximal tibia stress fractures. Materials and Methods: We analysed 15 patients with proximal tibia stress fractures associated with Grade 4 knee osteoarthritis. The mean age was 66 years (range, 52–80) and included seven men and eight women. Diagnosis of stress fractures was seen on x rays and clinical examination. Standing X Ray views were obtained for all patients preoperatively and postoperatively. All patients were treated with TKA with long stem (PCL sacrificing). Union of the fracture site studied using plain anteroposterior (AP) and lateral leg x-rays at regular intervals. Results: The mean follow-up period was 17.2 weeks (range of 12–24) months. All patients experienced significant reduction in pain and improvement in functional status. The range of motion of the knee improved significantly. Flexion of knee improved from mean of 88 degrees (60-110) to 122 degrees (100-140). The fixed flexion deformity also decreased from mean of 10 degrees (5-15) to mean of 1 degree (0-5) The Knee Society score and Knee Society functional score had excellent improvements of approximately 825 and 83% respectively. All proximal tibia stress fractures were united till with an average time of 10 weeks (8-12 weeks). Conclusion: Single- stage Long stem TKR is a good and reliable surgical option for proximal tibial stress fractures with grade 4 OA.