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

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