One-Stage Long-Stem Total Knee Arthroplasty for Arthritic Knees with Stress Fractures

Abstract

purpose. To evaluate the outcome of one-stage longstem 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 fixedbearing 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 23.2º to 1.9º varus. The mean Knee Society knee score improved from 38.5 (range, 15-63) to 89.6 (range, 80-95)

Proximal fibular resection improves knee biomechanics and enhances tibial stress fracture healing in patients with osteoarthritis with varus deformity: a prospective, randomized control analysis

“…1). All stress fractures diagnosed by radiographic findings, including frank cortical break, periosteal reaction, endosteal callus, and horizontal or oblique patterns of sclerotic area [13]. The exclusion criteria were: (1) genu valgus or acute major trauma; (2) preoperative evidence of infection (erythrocyte sedimentation rate and C-reactive protein); (3) known history of cardiovascular diseases or cerebral vascular diseases; (4) neuropathy; (5) a history of patellar fracture, patellectomy, patello-femoral instability or prior unicondylar knee replacement or HTO; (6) hypersensitivity to NSAIDs or local anesthetic agents; (7) preoperative abnormal hepatic or renal profile; (8) history of peptic ulceration and upper gastrointestinal hemorrhage, cancer, hyperkalaemia; (9) known history of coagulopathies, hematological or neuro-muscular disorders; (10) known psychiatric diagnosis and/or any other circumstances that would make participation not in the best interest of the cohort or could prevent the protocolspecified outcome evaluation.…”

Primary osteosynthesis augmented with autologous bone graft with total knee arthroplasty in patients with stress fractures of medial femoral condyle with knee osteoarthritis: a cost effective approach

“…The first and foremost option is a single stage total knee arthroplasty with long stem extension of the femoral component to bypass the fracture site. 14 This would have been feasible in our series if the fracture had occurred in the metaphyseo-diaphyseal region. In the present series the stress fracture is intraarticular extending from intercondylar notch to medial cortex of femur.…”

“…To our knowledge the studies discussing the outcome of single stage TKR and internal fixation of medial femoral stress fracture are sparse in the literature. 14 In spite of the existing controversy regarding the safety of one-stage TKR and internal fixation of stress fracture, we prefer this approach in these patients due to its significant cost advantages and other benefits viz. speedy recovery, early rehabilitation, shorter hospital stay, single-session anaesthetic risk and avoids multiple surgeries.…”

“…[11][12][13][14] Stress fracture of medial femoral condyle secondary to deformities from osteoarthritis is uncommon, and may be difficult to manage. Stress fracture are often treated conservatively viz splint/or casting and rest.…”

Using 3D Scanning Techniques in Orthopedic Systems Modeling

“…From the mechanical point of view, the main causes of failure that arise from the knee joint replacement operation are [6]: the polyethylene wear from which the insert 2 is made, the failure of the femoral component cement 1 and the tibial component 3 or even the implant breakage [7,8] . In order to minimize these issues, the virtual model of the parts that make up the implant and the virtual model of the bones in which it is mounted are made and the virtual bone-implant assembly is analyzed, both cinematically and in terms of mechanical resistance (Finite element analysis).…”