Periprosthetic fractures of the tibial shaft following long-stemmed total knee arthroplasty: A case report

BACKGROUND Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty (TKA). Therefore, there is still clinical debate regarding the appropriate treatment method. This study presents the case of a patient with two successive periprosthetic fractures of the tibial shaft treated with revision TKA (rTKA) and intramedullary fixation. CASE SUMMARY A 65-year-old woman was treated for tibial shaft pseudarthrosis after a periprosthetic fracture. The patient underwent rTKA with a tibial component exchange to a long-stemmed implant. At her 1.5-year follow-up visit, partial asymptomatic bone union was noted with no prosthesis loosening. The patient achieved 0° to 120° range of motion and a stable knee, and reported high satisfaction. Improvements were observed in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from 74 to 17, and in the knee society scores (KSS) from 56 to 91 (clinical) and 10 to 80 (functional). After 2.5 years, the patient sustained a second fracture below the original site due to low-energy trauma. The rTKA with intramedullary stabilization was performed. One year later, WOMAC and clinical and functional KSS were 15, 81, and 80, respectively. Despite tibial shortening and lower limb inequality, the patient remains very satisfied and does not experience any issues with daily activities nor weight-bearing. CONCLUSION There is little consensus in the literature on the management of tibial shaft periprosthetic fractures. Intramedullary stabilization may yield excellent outcomes, but individual case discussion is necessary for rTKA indications.