Primary Total Knee Replacement in a Case of Lateral Tibial Condyle Delayed Union with Severe Grade 4 Osteoarthritis Knee - A Case Report.

ABSTRACT

INTRODUCTION: Tibial plateau fractures are not uncommon. These fractures occur in bimodal age distribution consisting of 8% of all geriatric fractures. They usually occur as a result of low-energy trauma in the elderly. The management options include closed/open reduction and internal fixation (ORIF) using screws and plates. The osteosynthetic treatment options cause malreduction, non-union, implant failure in elderly patients due to osteoporosis and this may lead to post-traumatic arthritis, requiring total knee replacement (TKR) as a secondary procedure later. CASE REPORT A 76-year-old male patient presented with pain and swelling in the left knee with a history of trauma to the left knee. X-ray of the left knee showed the split fracture of the left lateral tibial condyle with severe Grade 4 osteoarthritis. On examination, tenderness was present over the lateral tibial condyle. We managed with cemented primary TKR using stemmed tibial component. Postoperatively, the patient is having good knee range of motion and having no difficulty in walking and weight-bearing. Functional outcome is good as per Oxford knee score. CONCLUSION: Primary TKR is a viable alternative treatment option compared to ORIF in elderly patients with preexisting osteoarthritis with tibial condyle fractures. It helps in early mobilization, weight-bearing and avoids secondary surgical procedures.