SUMMARY
Introduction/Objective Proximal tibial stress fractures associated with bilateral severe knee osteoarthritis
are rare and, due to possible consequences, are considered a treatment challenge. This paper aims to
present the applied treatment method of these patients and its results.
Methods A prospective study followed 14 patients with an average age of 74.1 years and with unilateral
proximal tibial stress fracture associated with bilateral severe knee osteoarthritis. Surgical treatment
involved modular total knee arthroplasty (TKA) on the fracture side, in the first act, and contralateral
standard TKA, in the second act, based on the severe osteoarthritis. Rehabilitation was performed for 21
days after both operations and included the following: kinesiotherapy, electrotherapy, magnetotherapy,
hydrotherapy, and thermotherapy. Monitoring parameters were as follows: X-ray, range of motion, and
WOMAC index. Monitoring periods were preoperative and three, six, and nine months after the first
TKA surgery.
Results The radiological findings in all patients during these follow-up periods were normal. All tibial
stress fractures healed within six months after surgery. Knee function was significantly improved nine
months after the first TKA surgery compared to the preoperative finding. A statistically significant improvement
in the physical functioning was found in all postoperative periods, especially nine months
after the first TKA surgery (p < 0.05).
Conclusion Modular total knee arthroplasty on the tibial stress fracture side and delayed standard total
knee arthroplasty of contralateral osteoarthritic knee combined by postoperative inpatient rehabilitation
give optimal final functional outcome.
