Analysis of clinical and radiological outcomes of long tibial stemmed total knee arthroplasty in knee osteoarthritis complicated by tibial stress fracture

Objective Knee 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. Methods From 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. Results The 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 degrees to a mean of 0.29 degrees, and knee flexion improved from 79.4 +/- 13.90 degrees to 125.29 +/- 8.74 degrees 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). Conclusion Total knee arthroplasty using long tibial extenders has been an effective and safe surgical option for patients with advanced osteoarthritis with tibial stress fractures.