Single-stage internal fixation with knee arthroplasty: a novel approach for concurrent knee osteoarthritis and distal femoral fracture

This study investigates the clinical outcomes of single-stage internal fixation combined with total knee arthroplasty (TKA) for treating distal femoral fractures with concurrent knee osteoarthritis (OA). We report a case of a 68-year-old female patient who sustained a displaced distal femoral spiral fracture (AO/OTA type A1.2) and severe knee OA (Kellgren-Lawrence grade IV). The patient underwent single-stage surgery involving locked compression plating for fracture fixation and primary TKA. Postoperatively, the patient was allowed immediate weight-bearing and aggressive rehabilitation. At 4-year follow-up, the patient demonstrated significant functional improvement, with an Oxford Knee Score of 36.8 and a visual analog scale (VAS) pain score of 1.9. Radiographs showed no implant loosening and normal knee alignment. This case highlights the feasibility and effectiveness of single-stage internal fixation combined with TKA for elderly patients with osteoporotic distal femoral fractures and knee OA, offering a promising treatment option for such complex cases.