Total knee arthroplasty for arthritic knees with tibiofibular stress fractures: classification and treatment guidelines.

Forty-two tibial and 5 fibular stress fractures in 34 patients with knee arthritis were radiologically classified into intraarticular malunited and ununited fractures, and extraarticular impending, acute, united, malunited, and ununited fractures. Depending on fracture type, total knee arthroplasty was performed using long-stem tibial component, metal augments, corrective osteotomy, or in routine fashion. At a mean follow-up of 36 months, the mean Knee Society knee score improved from 36.7 points preoperatively to 90.3 points; function score improved from 24 to 86.2 points. All fractures had united at the last follow-up with no complications of infection, joint instability, and patellar problems. Total knee arthroplasty for knee arthritis in the presence of tibiofibular stress fractures restores limb alignment and facilitates fracture healing with excellent functional outcome.