Kocon M, Grzelecki D. Periprosthetic fractures of the tibial shaft following long-stemmed total knee arthroplasty: A case report. World J Orthop 2025; 16(2): 98674 [DOI: 10.5312/wjo.v16.i2.98674]
Corresponding Author of This Article
Dariusz Grzelecki, MD, PhD, Associate Professor, Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Konarskiego 13, Otwock 05-400, Mazowieckie, Poland. dariuszgrzelecki@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Feb 18, 2025; 16(2): 98674 Published online Feb 18, 2025. doi: 10.5312/wjo.v16.i2.98674
Periprosthetic fractures of the tibial shaft following long-stemmed total knee arthroplasty: A case report
Maciej Kocon, Dariusz Grzelecki
Maciej Kocon, Dariusz Grzelecki, Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Otwock 05-400, Mazowieckie, Poland
Author contributions: Kocon M was responsible for data collection, article conceptualization and drafting, and manuscript revisions; Grzelecki D was a major contributor to the writing of the manuscript; all authors have read and approved the manuscript.
Informed consent statement: Written informed consent was obtained from the patient to publish this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dariusz Grzelecki, MD, PhD, Associate Professor, Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Konarskiego 13, Otwock 05-400, Mazowieckie, Poland. dariuszgrzelecki@gmail.com
Received: July 2, 2024 Revised: November 19, 2024 Accepted: January 7, 2025 Published online: February 18, 2025 Processing time: 224 Days and 13.9 Hours
Abstract
BACKGROUND
Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty (TKA). Therefore, there is still clinical debate regarding the appropriate treatment method. This study presents the case of a patient with two successive periprosthetic fractures of the tibial shaft treated with revision TKA (rTKA) and intramedullary fixation.
CASE SUMMARY
A 65-year-old woman was treated for tibial shaft pseudarthrosis after a periprosthetic fracture. The patient underwent rTKA with a tibial component exchange to a long-stemmed implant. At her 1.5-year follow-up visit, partial asymptomatic bone union was noted with no prosthesis loosening. The patient achieved 0° to 120° range of motion and a stable knee, and reported high satisfaction. Improvements were observed in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from 74 to 17, and in the knee society scores (KSS) from 56 to 91 (clinical) and 10 to 80 (functional). After 2.5 years, the patient sustained a second fracture below the original site due to low-energy trauma. The rTKA with intramedullary stabilization was performed. One year later, WOMAC and clinical and functional KSS were 15, 81, and 80, respectively. Despite tibial shortening and lower limb inequality, the patient remains very satisfied and does not experience any issues with daily activities nor weight-bearing.
CONCLUSION
There is little consensus in the literature on the management of tibial shaft periprosthetic fractures. Intramedullary stabilization may yield excellent outcomes, but individual case discussion is necessary for rTKA indications.
Core Tip: Periprosthetic tibial fractures after long-stemmed total knee arthroplasties require planning and a personalized approach for each case. We recommend planning intramedullary fixation with long-stemmed implants or revision total knee arthroplasty with intramedullary nailing for fractures localized on the tibial shaft.
