Effectiveness of one-stage total knee arthroplasty with tibial stem extender for knee arthritis complicated with tibial stress fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN Wenjie ¹ , HE Yan ² ,  MA Jianbing ¹ , XIAO Lin ¹ , JIANG Kuo ¹

1. Department of Bone and Joint Surgery, Xi’an Honghui Hospital, Affiliated to Medical College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;
2. Department of Pharmacy, Xi’an No.4 Hospital, Xi’an Shaanxi, 710004, P.R.China;

Corresponding author：

MA Jianbing, Email: sxhz938@163.com

Keywords：

Knee arthritis; tibial stress fracture; total knee arthroplasty

DOI：

10.7507/1002-1892.201802047

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ObjectiveTo evaluate the early effectiveness of one-stage total knee arthroplasty (TKA) with tibial stem extender for knee arthritis complicated with tibial stress fractures. MethodsBetween January 2014 and November 2016, 12 patients (12 knees) with knee arthritis and tibial stress fractures underwent one-stage TKA with tibial stem extender. There were 5 males and 7 females with an average age of 71.5 years (range, 60-77 years). There were 8 cases with osteoarthritis and 4 cases with rheumatoid arthritis. The radiographic examination showed the 6 cases of intra-articular fractures and 6 of extra-articular fractures (including transverse fractures in 4 cases and short oblique fractures in 2 cases); 2 cases complicated with middle and upper fibular fractures; 12 cases of varus deformities. Preoperative Knee Society Score (KSS) clinical score was 31.5±8.4 and functional score was 33.3±9.0. The preoperative range of motion (ROM) of the knee was (65.6±9.6)°. ResultsAll incisions healed primarily and no wound infection or skin necrosis occurred. All patients were followed up 36.5 months on average (range, 6-52 months). X-ray films showed that all fractures healed at 3-7 months (mean, 4 months); the position of the prosthesis was good, and no loosening or signs of infection occurred. At last follow-up, the KSS clinical score was 90.5±8.9 and functional score was 92.1±7.8; the ROM of the knee was (115.0±9.8)°. All indexes were significantly improved than those before operation (t=40.340, P=0.000; t=32.120, P= 0.000; t=8.728, P=0.000). ConclusionOne-stage TKA with tibial stem extender for patients with knee arthritis and tibial stress fractures can restore limb alignment, facilitate fracture healing, and obtain the satisfactory early effectiveness.

Citation： PAN Wenjie, HE Yan, MA Jianbing, XIAO Lin, JIANG Kuo. Effectiveness of one-stage total knee arthroplasty with tibial stem extender for knee arthritis complicated with tibial stress fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1177-1180. doi: 10.7507/1002-1892.201802047 Copy

1.	Wheeldon FT. Spontaneous fractures in the shin in the presence of knee deformities. Proc R Soc Med, 1961, 54: 1108.
2.	Satku K, Kumar VP, Pho RW. Stress fractures of the tibia in osteoarthritis of the knee. J Bone Joint Surg (Br), 1987, 69(2): 309-311.
3.	Martin LM, Bourne RB, Rorabeck CH. Stress fractures associated with osteoarthritis of the knee. A report of three cases. J Bone Joint Surg (Am), 1988, 70(5): 771-774.
4.	Learmonth ID, Grobler G. Sequential stress fractures of the tibia associated with osteo-arthritis of the knee. A case report. S Afr J Surg, 1990, 28(2): 75-77.
5.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
6.	Ebied A, Zayda A, Marei S, et al. Medium term results of total knee arthroplasty as a primary treatment for knee fractures. SICOT J, 2018, 4: 6.
7.	Mullaji A, Shetty G. Total knee arthroplasty for arthritic knees with tibiofibular stress fractures: classification and treatment guidelines. J Arthroplasty, 2010, 25(2): 295-301.
8.	Moskal JT, Mann JW 3rd. Simultaneous management of ipsilateral gonarthritis and ununited tibial stress fracture: combined total knee arthroplasty and internal fixation. J Arthroplasty, 2001, 16(4): 506-511.
9.	Sawant MR, Bendall SP, Kavanagh TG, et al. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty. J Bone Joint Surg (Br), 1999, 81(4): 663-666.
10.	Tomlinson MP, Dingwall IM, Phillips H. Total knee arthroplasty in the management of proximal tibial stress fractures. J Arthroplasty, 1995, 10(5): 707-713.
11.	Mittal A, Bhosale PB, Suryawanshi AV, et al. One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures. J Orthop Surg (Hong Kong), 2013, 21(2): 199-203.
12.	Soundarrajan D, Rajkumar N, Dhanasekararaja P, et al. Proximal tibia stress fracture with Osteoarthritis of knee—Radiological and functional analysis of one stage TKA with long stem. SICOT J, 2018, 4: 13.

1. Wheeldon FT. Spontaneous fractures in the shin in the presence of knee deformities. Proc R Soc Med, 1961, 54: 1108.
2. Satku K, Kumar VP, Pho RW. Stress fractures of the tibia in osteoarthritis of the knee. J Bone Joint Surg (Br), 1987, 69(2): 309-311.
3. Martin LM, Bourne RB, Rorabeck CH. Stress fractures associated with osteoarthritis of the knee. A report of three cases. J Bone Joint Surg (Am), 1988, 70(5): 771-774.
4. Learmonth ID, Grobler G. Sequential stress fractures of the tibia associated with osteo-arthritis of the knee. A case report. S Afr J Surg, 1990, 28(2): 75-77.
5. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
6. Ebied A, Zayda A, Marei S, et al. Medium term results of total knee arthroplasty as a primary treatment for knee fractures. SICOT J, 2018, 4: 6.
7. Mullaji A, Shetty G. Total knee arthroplasty for arthritic knees with tibiofibular stress fractures: classification and treatment guidelines. J Arthroplasty, 2010, 25(2): 295-301.
8. Moskal JT, Mann JW 3rd. Simultaneous management of ipsilateral gonarthritis and ununited tibial stress fracture: combined total knee arthroplasty and internal fixation. J Arthroplasty, 2001, 16(4): 506-511.
9. Sawant MR, Bendall SP, Kavanagh TG, et al. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty. J Bone Joint Surg (Br), 1999, 81(4): 663-666.
10. Tomlinson MP, Dingwall IM, Phillips H. Total knee arthroplasty in the management of proximal tibial stress fractures. J Arthroplasty, 1995, 10(5): 707-713.
11. Mittal A, Bhosale PB, Suryawanshi AV, et al. One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures. J Orthop Surg (Hong Kong), 2013, 21(2): 199-203.
12. Soundarrajan D, Rajkumar N, Dhanasekararaja P, et al. Proximal tibia stress fracture with Osteoarthritis of knee—Radiological and functional analysis of one stage TKA with long stem. SICOT J, 2018, 4: 13.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of one-stage total knee arthroplasty with tibial stem extender for knee arthritis complicated with tibial stress fracture

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