Management of proximal tibial shaft stress fracture with grade 4 osteoarthritis knee: Total knee replacement with immediate weight bearing: A case report

Introduction: Proximal tibial shaft stress fractures coexisting with severe osteoarthritis (OA) knee present a challenging clinical scenario. This case report presents a novel approach to address both conditions simultaneously through total knee replacement (TKR), avoiding the traditional sequential approach of fracture fixation followed by TKR. Case Presentation: A 75-year-old female patient with a proximal tibial shaft stress fracture and grade 4 OA knee was managed with TKR using a regular femur implant and stem extenders for the tibial side. Additionally, a medial tibial condyle defect was addressed using bone cement. Immediate weight-bearing was initiated postoperatively. Radiological union was observed at 3 months, with preoperative range of motion (ROM) at 10-60 degrees improving to 0-120 degrees postoperatively. Knee Society Scores improved significantly from 11 (part 1) and 0 (part 2) preoperatively to 89 (part 1) and 80 (part 2) postoperatively, indicating excellent outcomes. Discussion: This case highlights the efficacy of TKR as a comprehensive solution for managing concurrent proximal tibial shaft stress fractures and severe OA knee. By addressing both conditions simultaneously, this approach minimizes the need for multiple surgeries, reduces morbidity, and allows for early rehabilitation and functional recovery. Conclusion: Total knee replacement with immediate weight bearing is a promising approach for treating proximal tibial shaft stress fractures in the setting of severe OA knee. This method offers excellent outcomes, addressing both conditions effectively in a single surgical procedure, thus improving patient satisfaction and reducing the overall burden of treatment.