One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures

Purpose. To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures. Methods. Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively. Results. The mean follow-up period was 51 (range, 24-96) months. The mean tibiofemoral angle improved from 23.2 degrees to 1.9 degrees varus. The mean Knee Society knee score improved from 38.5 (range, 1563) to 89.6 (range, 80-95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0-40) to 86.5 (range, 60-100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered. Conclusion. One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.