Management of Osteoarthritis of the Knee Presenting With Proximal Tibial Stress Fracture

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Viroj Kawinwonggowit
Ittirat Watcharananan
Siwadol Wongsak


Tibial stress fracture secondary to deformities from osteoarthritis of the knee is very rare, and management of this condition is difficult. We treated one patient who had osteoarthritis of left knee with stress fracture of the proximal tibial diaphysis. We performed total knee arthoplasty with long tibial stem component. The result is excellent; she can walk without gait aid within three months.

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Kawinwonggowit, V., Watcharananan, I., & Wongsak, S. (2018). Management of Osteoarthritis of the Knee Presenting With Proximal Tibial Stress Fracture. Ramathibodi Medical Journal, 36(3), 226–234. Retrieved from
Case Reports


Milgrom C, Finestone A, Shlamkovitch N, et al. Youth is a risk factor for stress fracture. A study of 783 infantry recruits. J Bone Joint Surg Br. 1994;76(1):20-22.

Bauer G, Gustafsson M, Mortensson W, Norman O. Insufficiency fractures in the tibial condyles in elderly individuals. Acta Radiol Diagn (Stockh). 1981;22(5):619-622.

Young A, Kinsella P, Boland P. Stress fractures of the lower limb in patients with rheumatoid arthritis. J Bone Joint Surg Br. 1981;63-B(2):239-243.

Schneider R, Kaye JJ. Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis. Radiology. 1975;116(3):595-599.

Devas M. Stress Fractures. Edinburgh, Scotland: Churchill Livingstone; 1975.

Grundy J. Fractures of the femur in Paget's disease of bone. J Bone Joint Surg Br. 1970;52:252-263.

Tomlinson MP, Dingwall IM, Phillips H. Total knee arthroplasty in the management of proximal tibial stress fractures. J Arthroplasty. 1995;10(5):707-713.

Daffner RH, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol. 1992;159(2):245-252.

Carpintero P, Berral FJ, Baena P, Garcia-Frasquet A, Lancho JL. Delayed diagnosis of fatigue fractures in the elderly. Am J Sports Med. 1997;25(5):659-662.

Martin LM, Bourne RB, Rorabeck CH. Stress fractures associated with osteoarthritis of the knee. a report of three cases. J Bone Joint Surg Am. 1988;70(5):771-774.

Sawant MR, Bendall SP, Kavanagh TG, Citron ND. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty. J Bone Joint Surg Br. 1999;81(4):663-666.

Templeton PA, Newman RJ, Sefton GK. Treatment of diaphyseal tibial stress fractures associated with knee osteoarthrosis. Injury. 1995;26(6):419-420.

Satku K, Kumar VP, Chacha PB. Stress fractures around the knee in elderly patients. A cause of acute pain in the knee. J Bone Joint Surg Am. 1990;72(6):918-922.

Gacon G, Barba L, Lalain JJ, et al. Stress fractures of the tibia: uncommon mechanical complication of osteoarthritis of the knee. report of 3 cases. Rev Chir Orthop Reparatrice Appar Mot. 1990;76(3):209-214.

Satku K, Kumar VP, Pho RW. Stress fractures of the tibia in osteoarthritis of the knee. J Bone Joint Surg Br. 1987;69(2):309-311.

Reynolds MT. Stress fractures of the tibia in the elderly associated with knee deformity. Proc R Soc Med. 1972;65(4):377-380.

Cameron HU. Double stress fracture of the tibia in the presence of arthritis of the knee. Can J Surg. 1993;36(4):307-310.

Moskal JT, Mann JW 3rd. Simultaneous management of ipsilateral gonarthritis and ununited tibial stress fracture: combined total knee arthroplasty and internal fixation. J Arthroplasty. 2001;16(4):506-511.