Total knee arthroplasty in patients with a proximal tibial stress fracture associated with bilateral severe knee osteoarthritis

Abstract

Introduction/Objective. Proximal tibial stress fractures associated with bilateral severe knee osteoarthritis are rare and, due to possible consequences, are considered a treatment challenge. This paper aims to present the applied treatment method of these patients and its results. Methods. A prospective study followed 14 patients with an average age of 74.1 years and with unilateral proximal tibial stress fracture associated with bilateral severe knee osteoarthritis. Surgical treatment involved modular total knee arthroplasty (TKA) on the fracture side, in the first act, and contralateral standard TKA, in the second act, based on the severe osteoarthritis. Rehabilitation was performed for 21 days after both operations and included the following: kinesiotherapy, electrotherapy, magnetotherapy, hydrotherapy, and thermotherapy. Monitoring parameters were as follows: X-ray, range of motion, and WOMAC index. Monitoring periods were preoperative and three, six, and nine months after the first TKA surgery. Results. The radiological findings in all patients during these follow-up periods were normal. All tibial stress fractures healed within six months after surgery. Knee function was significantly improved nine months after the first TKA surgery compared to the preoperative finding. A statistically significant improvement in the physical functioning was found in all postoperative periods, especially nine months after the first TKA surgery (p < 0.05). Conclusion. Modular total knee arthroplasty on the tibial stress fracture side and delayed standard total knee arthroplasty of contralateral osteoarthritic knee combined by postoperative inpatient rehabilitation give optimal final functional outcome.