Long- Stem Total Knee Arthroplasty for Proximal Tibial Stress Fractures in the Elderly Patients

Abstract

Background: Presentation of proximal tibia stress fracture is not infrequent among elderly patients due to their poor<br />bone stock. Optimal management of patients with severe gonarthrosis of the knee and concurrent tibial stress fracture is<br />not known yet. In this study we report the outcome of primary total knee arthroplasty (TKA) using stemmed components<br />in elderly patients.<br />Methods: Between 2009 and 2014, a total of 16 elderly patients with proximal tibial stress fractures and concurrent<br />gonarthrosis were treated with TKA using long stemmed components. The diagnosis of stress fractures was confirmed<br />based on the radiographic changes. A standing alignment view was obtained for all patients preoperatively. Union of<br />the fracture site was investigated using plain anteroposterior (AP) and lateral leg x-rays.<br />Results: All patients experienced significant relieve of symptoms. The Knee Society score and Knee Society functional<br />score averaged 86±4 and 85±6, respectively. The mean arc of motion of the knee was 118°±2° at the latest follow-up. All<br />stress fractures resolved at a mean of 8.3±1.1 weeks. The medial proximal tibial angle was increased from 74.7°±5.7°<br />preoperatively to 90.3°±1.1° (P<0.05) postoperatively. Tegner activity scale was increased from 2.1±1.3 to 3.4±0.9<br />(P<0.05).<br />Conclusion: According to our findings, patients with stress fracture of proximal tibia and concurrent gonarthrosis<br />can be treated with primary TKA using stemmed components that may bypass the stress fracture and allow<br />healing of the fracture.<br />Level of evidence: IV