Long-Stem Bypass Fixation for Concomitant Tibial Stress Fractures and Advanced Knee Arthritis: A Prospective Clinical Study
Abstract
Introduction: Proximal tibial stress and insufficiency fractures occurring with advanced knee arthritis create a combined problem of articular degeneration, deformity, poor bone quality, and fracture instability. This study evaluated clinical and radiographic outcomes of single-stage total knee arthroplasty (TKA) using a long tibial stem to bypass and internally stabilize the fracture while correcting limb alignment. Materials and Methods: This prospective clinical study included 18 consecutive patients treated between January 2021 and January 2024 at a tertiary orthopedic referral center. Six fractures were acute, and 12 were chronic or established non-unions; three patients had intra-articular proximal tibial involvement. All patients underwent posterior-stabilized TKA with a 100–150 mm tibial stem extending at least two cortical diameters beyond the fracture. Mechanical alignment, fluoroscopic control, manual sequential reaming, and proximal hybrid cementation were used. Medial plateau defects were augmented with screws or wedges when required. Knee Society Score (KSS), Knee Society Function Score, range of motion (ROM), coronal deformity, fracture union, and implant-related complications were evaluated over a minimum 24-month follow-up. Results: Mean follow-up was 24.44 ± 7.10 months. KSS improved from 15.44 ± 10.26 to 90.72 ± 2.85, and Function Score from 8.06 ± 5.72 to 85.00 ± 5.42. Mean ROM improved from 103.89° ± 20.04° to 122.78° ± 8.95°, while mean varus deformity decreased from 24.72° ± 5.87° to 5.94° ± 0.94°; all comparisons were significant at P < 0.001. Fracture union was achieved in all 18 patients, including all 12 chronic cases. No implant loosening, stress shielding, or periprosthetic fracture was observed. Conclusion: In this small, uncontrolled prospective cohort, single-stage long-stem TKA was associated with fracture union, deformity correction, and functional improvement in advanced arthritic knees complicated by proximal tibial stress fractures. Because fracture bypass fixation, alignment correction, and bone-health optimization were delivered concurrently, the independent contribution of the long-stem component cannot be isolated. Larger multicenter comparative studies with longer follow-up are required to confirm these findings.
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BibTeX
@article{jain2026longstem,
title = {{Long-Stem Bypass Fixation for Concomitant Tibial Stress Fractures and Advanced Knee Arthritis: A Prospective Clinical Study}},
author = {Jitesh Kumar Jain and Ruchi Goyal and Harish Bansal},
journal = {Journal of Orthopaedic Case Reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8492},
url = {https://doi.org/10.13107/jocr.2026.v16.i11.8492},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Long-Stem Bypass Fixation for Concomitant Tibial Stress Fractures and Advanced Knee Arthritis: A Prospective Clinical Study
AU - Jitesh Kumar Jain
AU - Ruchi Goyal
AU - Harish Bansal
PY - 2026
DA - 2026/11/09
JO - Journal of Orthopaedic Case Reports
DO - 10.13107/jocr.2026.v16.i11.8492
UR - https://doi.org/10.13107/jocr.2026.v16.i11.8492
AB - Introduction: Proximal tibial stress and insufficiency fractures occurring with advanced knee arthritis create a combined problem of articular degeneration, deformity, poor bone quality, and fracture instability. This study evaluated clinical and radiographic outcomes of single-stage total knee arthroplasty (TKA) using a long tibial stem to bypass and internally stabilize the fracture while correcting limb alignment. Materials and Methods: This prospective clinical study included 18 consecutive patients treated between January 2021 and January 2024 at a tertiary orthopedic referral center. Six fractures were acute, and 12 were chronic or established non-unions; three patients had intra-articular proximal tibial involvement. All patients underwent posterior-stabilized TKA with a 100–150 mm tibial stem extending at least two cortical diameters beyond the fracture. Mechanical alignment, fluoroscopic control, manual sequential reaming, and proximal hybrid cementation were used. Medial plateau defects were augmented with screws or wedges when required. Knee Society Score (KSS), Knee Society Function Score, range of motion (ROM), coronal deformity, fracture union, and implant-related complications were evaluated over a minimum 24-month follow-up. Results: Mean follow-up was 24.44 ± 7.10 months. KSS improved from 15.44 ± 10.26 to 90.72 ± 2.85, and Function Score from 8.06 ± 5.72 to 85.00 ± 5.42. Mean ROM improved from 103.89° ± 20.04° to 122.78° ± 8.95°, while mean varus deformity decreased from 24.72° ± 5.87° to 5.94° ± 0.94°; all comparisons were significant at P < 0.001. Fracture union was achieved in all 18 patients, including all 12 chronic cases. No implant loosening, stress shielding, or periprosthetic fracture was observed. Conclusion: In this small, uncontrolled prospective cohort, single-stage long-stem TKA was associated with fracture union, deformity correction, and functional improvement in advanced arthritic knees complicated by proximal tibial stress fractures. Because fracture bypass fixation, alignment correction, and bone-health optimization were delivered concurrently, the independent contribution of the long-stem component cannot be isolated. Larger multicenter comparative studies with longer follow-up are required to confirm these findings.
SN - 2250-0685
SN - 2321-3817
ER -