Lifelong Sequelae of a Childhood Tibial Fracture: Severe Procurvatum Tibial Malunion Leading to Secondary Knee Osteoarthritis

The sequelae of tibial malunion following surgical repair in the pediatric population are well documented. Persistent tibial malunion introduces varus or valgus forces that predispose patients to knee compartment overload, limiting ambulation and promoting osteoarthritis and osteoporosis. To prevent these sequelae, tibial malunions are categorized by deformity severity to guide surgical interventions, including intra-articular, extra-articular, and combined approaches. A male in his early 70s presented to the orthopedic clinic for reevaluation of severe right knee osteoarthritis secondary to a longstanding tibial malunion healed in malalignment after failed fixation and the absence of revision surgery. Radiographs demonstrated a 57.2-degree procurvatum and 30.9-degree valgus deformity of the tibia. Initial management included multiple courses of intra-articular corticosteroid injections that provided minimal relief, with progressively worsening ambulation due to knee pain. A total knee arthroplasty was performed. Intraoperative challenges included poor bone quality and retained tibial hardware, limiting stem length and placement. At three months postoperatively, the patient reported significant improvement in ambulatory capacity and knee pain despite the persistence of the extra-articular deformity. There are limited reports of severe tibial malunions persisting into the geriatric period, as well as their long-term biomechanical consequences. Furthermore, there are limited reports describing total knee arthroplasty performed without correction of extra-articular deformity. This case suggests that, in select geriatric patients, extra-articular tibial deformities may be managed with isolated total knee arthroplasty when osteotomy is high-risk or undesirable. However, the findings are constrained by the single-case design, limited follow-up duration, and absence of objective postoperative alignment data.