Department of Orthopaedic Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, 600116, India.
Department of Orthopaedic Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, 600116, India.
Chin J Traumatol. 2022 Nov;25(6):357-361. doi: 10.1016/j.cjtee.2022.02.002. Epub 2022 Feb 26.
The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.
Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.
Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.
Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.
并发膝骨关节炎（OA）的胫骨应力性骨折的治疗和结果较为复杂。本研究旨在评估全膝关节置换术长胫骨柄治疗膝 OA 和胫骨应力性骨折患者的功能和影像学结果。
我们机构在 2013 年 6 月至 2018 年 11 月期间诊断出患有胫骨近端应力性骨折合并膝 OA 的患者纳入本研究。所有患者均接受长胫骨柄全膝关节置换术。根据膝关节活动范围、膝关节协会评分和膝关节损伤与 OA 结局评分对术前和术后功能进行评估。定量变量采用均值和标准差进行描述性分析，分类变量采用频率和比例进行描述性分析。
本研究纳入 12 例患者。所有患者均被发现胫骨近端存在应力性骨折和关节外骨折。4 例患者出现骨折不愈合/延迟愈合，8 例患者出现急性骨折。术前平均膝关节活动范围为 88.1°，术后 3 个月时改善至 116.3°。所有病例均发现骨折愈合。术前膝关节协会评分平均为 32.9 分，术后 1 年随访时提高至 89.3 分。膝关节损伤与 OA 结局评分从术前平均 28.3 分提高至术后 1 年随访时的 81.1 分。
膝 OA 患者可能在胫骨近端发生应力性骨折。胫骨柄全膝关节置换术可为两种情况提供合适的解决方案。不太可能需要额外的钢板或骨移植。
