Traumaplasty in Action - Staggered Bilateral Primary Total Knee Arthroplasty for Complex Proximal Tibial Fractures with Osteoarthritis - Case Report

Sep 30, 2026

Primary total knee arthroplasty (TKA) is presented as a safe, effective alternative to ORIF for selected patients with complex proximal tibial fractures complicated by advanced knee osteoarthritis. The report describes a 68-year-old man with bilateral proximal tibial metaphyseal and fibular fractures plus tibial tubercle avulsions after a fall. After thorough evaluation, staggered bilateral primary TKA was performed in a single admission using tibial stem extenders and low-profile plate fixation, followed by structured rehabilitation. At 1-year follow-up, excellent functional recovery was achieved.

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CategoryHealthcare

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Case Report

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Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 67-72 Traumaplasty inAction: Staggered Bilateral Primary Total Knee Arthroplasty for Complex Proximal Tibial Fractures with Osteoarthritis –ACase Report Reddy Vamsi Krishna Arcot1, Babaji Sitaram Thorat1, Avtar Singh Kamboj1, Abhijit Das1, Arshid HWani1, Kshitij Srivastav1 Learning Point of the Article: Primary TKA can be a safe and effective alternative to ORIF in selected patients with Complex Proximal tibia fractures with advanced arthritis, provided careful planning and expertise. Abstract Introduction: Proximal tibial fractures in elderly patients with coexisting advanced knee osteoarthritis pose a significant treatment challenge. Primary total knee arthroplasty (TKA) has emerged as a viable alternative in selected cases, offering stable fixation, early mobilization, and avoidance of staged procedures. To the best ofour knowledge, this is the first reported case of bilateral primary TKA performed for bilateral proximal tibial metaphyseal fractures with bilateral tibial tubercle avulsionsin the setting ofadvanced osteoarthritis. Case Report: Wereport the case ofa 68-year-old male who sustained bilateral proximal tibial metaphyseal and fibular fractures with associated tibial tubercle avulsions and advanced bilateral knee osteoarthritis following a fall. After thorough evaluation, the patient underwent staggered bilateral primary TKA ina single admission. Tibial stem extenderswereused to bypass the fracture sites, and tibial tubercle fixationwas achieved with low-profile plates. Post-operative rehabilitation included early mobilization, progressive weight-bearing, and structured physiotherapy. At 1-yearfollow-up, the patient demonstrated excellent functionalrecovery with good knee range of motion and independent ambulation. Conclusion: Primary TKAin the fracture setting can obviate the need for complex secondary procedures,reduce complicationrisks, and restore function more efficiently than conventional fixation in carefully selected patients. Meticulous pre-operative planning, careful patient optimization, surgical expertise, and the adjunctive use ofadvanced technologies such as robotics are critical to achieving optimal outcomes. Keywords: Traumaplasty, primary total knee arthroplasty, bilateral tibial fractures,robotics, osteoarthritis. Introduction Proximal tibia fractures are relatively common in the elderly, accounting for nearly 8% of all fractures inpatients over 65 years of age [1]. Standard treatment involves open reduction and internal fixation (ORIF), which remains the gold standard in younger patients [2 ] . However, in the elderly, outcomes following ORIF are often compromised by osteoporosis, comminution, poor compliance with non-weight-bearing rehabilitation, and the frequent coexistence of advanced knee osteoarthritis. Reported complications include malunion, implant failure, joint stiffness, and progression of secondary osteoarthritis, often necessitating subsequent total knee arthroplasty (TKA) [3]. Conversion TKA after failed fixation is technically demanding |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6456](https://doi.org/10.13107/jocr.2025.v15.i12.6456) | Author’s Photo Gallery | | | | | | | --- | --- | --- | --- | --- | --- | --- | | |
Dr. Reddy Vamsi Krishna Arcot |
Dr. Babaji Sitaram Thorat |
Dr. Avtar Singh Kamboj | | | | | |
1Department of Orthopaedics, Amandeep Hospitals, Amritsar, Punjab, India.
Address of Correspondence:
Dr. Reddy Vamsi Krishna Arcot,
Department of Orthopaedics, Amandeep Hospitals, G.T. Road, Amritsar-143001, Punjab, India. [E-mail:](E-mail: vamsi1995mpl@gmail.com)[ vamsi1995mpl@gmail.com](E-mail: vamsi1995mpl@gmail.com) | | | | | | | Submitted: 03/09/2025; Review: 21/10/2025; Accepted: November 2025; Published: December 2025 | | | |

FAQs

Why can primary TKA be an alternative to ORIF in elderly patients with complex proximal tibial fractures?

Advanced osteoarthritis and factors such as osteoporosis, comminution, and limited tolerance for non-weight-bearing rehabilitation can compromise ORIF outcomes. Primary TKA can provide immediate stability, support early mobilization, and help avoid complications related to delayed weight-bearing.

What surgical approach was used in the reported case?

The 68-year-old patient underwent staggered bilateral primary TKA in a single admission. Tibial stem extenders were used to bypass the fracture sites, and tibial tubercle fixation was performed with low-profile plates.

What were the outcomes at follow-up?

At 1-year follow-up, the patient demonstrated excellent functional recovery, with good knee range of motion and independent ambulation.

Sep 30, 2026

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