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

Document Type : RESEARCH PAPER


1 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Taleghani Hospital Research Development Unit, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: 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.
Methods: 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.
Results: 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
Conclusion: 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


Main Subjects

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