Shekhar Shubhankar, Rai Alok, Prakash Saket, Khare Tarun, Malhotra Rajesh
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Knee Surg Relat Res. 2023 Jan 19;35(1):4. doi: 10.1186/s43019-023-00178-2.
Proximal tibia stress fractures present a challenge when performing total knee arthroplasty (TKA) in knee arthritis (KA). The literature on treatment modalities for stress fractures with arthritis is varied and not systematically reviewed. We aimed to answer the questions: (1) Is long-stem TKA sufficient for stress fractures in arthritic knees? (2) Should stress fracture and KA be addressed simultaneously? (3) What is the role of augmentative procedures in stress fractures with knee arthritis? (4) Can a unified algorithm be established?
The PubMed and Cochrane databases were searched for keywords such as stress fracture, knee arthritis and total knee arthroplasty, published from January 1995 to 29 May 2022. A total of 472 records were screened down to 13 articles on the basis of our selection criteria. Ten data items were recorded from the included studies. The methodological index for non-randomised studies (MINORS) score for the included studies was 17 ± 3.
We found long-stem TKA to be sufficient for most cases and advocated for single-stage treatment of stress fractures and arthritis. Augmentative procedures play a role in the treatment, and a unified algorithm was drafted to guide treatment.
Single-stage management of advanced KA with a stress fracture causes less morbidity than a staged procedure. Long-stem TKA, with or without an augmentative procedure, is an excellent option.
在膝关节炎（KA）患者中进行全膝关节置换术（TKA）时，胫骨近端应力性骨折是一个挑战。关于关节炎合并应力性骨折的治疗方式的文献多种多样，且未进行系统综述。我们旨在回答以下问题：（1）长柄全膝关节置换术对关节炎膝关节的应力性骨折是否足够？（2）应力性骨折和膝关节炎是否应同时处理？（3）增强手术在膝关节炎合并应力性骨折中起什么作用？（4）能否建立一个统一的算法？
在PubMed和Cochrane数据库中搜索1995年1月至2022年5月29日发表的关键词，如应力性骨折、膝关节炎和全膝关节置换术。根据我们的选择标准，共筛选出472条记录，最终纳入13篇文章。从纳入的研究中记录了10项数据。纳入研究的非随机研究方法学指数（MINORS）评分为17±3。
我们发现长柄全膝关节置换术对大多数病例足够，并主张对应力性骨折和关节炎进行一期治疗。增强手术在治疗中起作用，并起草了一个统一的算法来指导治疗。
对晚期膝关节炎合并应力性骨折进行一期治疗比分期治疗的发病率更低。长柄全膝关节置换术，无论是否进行增强手术都是一个很好的选择。
