Bilateral Knee Osteoarthritis with Bilateral Intra-Articular Fractures (Ipsilateral Femoral Condyle and Contralateral Tibial Condyle) Treated by Combined Total Knee Replacement and Fracture Reconstruction/Fixation in a 73-Year-Old Male Patient: First Case

Akshaya Kumar  Mehara

doi:10.51168/sjhrafrica.v7i3.2621

Authors

Akshaya Kumar Mehara Senior professor, Department of Orthopaedics, RNTMC Udaipur, Rajasthan

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2621

Keywords:

bilateral knee osteoarthritis, intra-articular fracture, femoral condyle fracture, tibial condyle fracture, total knee replacement, fracture fixation, single-stage arthroplasty, elderly trauma, case report

Abstract

Background: Bilateral knee osteoarthritis combined with concurrent bilateral intra-articular fractures involving asymmetric fracture patterns on each side — specifically, a femoral condyle fracture on one limb and a tibial condyle fracture on the contralateral limb — is an exceptionally rare clinical scenario. No prior publication has documented operative management of this combination through a single-stage procedure encompassing bilateral total knee replacement (TKR) alongside fracture reconstruction and internal fixation.

Case Presentation: A 73-year-old male with longstanding bilateral knee osteoarthritis presented following an inability to bear weight on both lower limbs for eight months. Imaging confirmed a femoral condyle fracture superimposed on Kellgren-Lawrence Grade IV osteoarthritis of the right knee, and a medial tibial condyle fracture over end-stage left knee arthritis. A three-stage surgical approach was undertaken: right-sided TKR with DFLCP (24 December 2025), left high tibial osteotomy with iliac crest bone graft and plate revision (31 December 2025), and left TKR (31 January 2026).

Outcome: Deformity was corrected bilaterally and limb length was restored. Non-weight-bearing ambulation commenced on the third postoperative day following the final stage. Knee Society Score improved from a combined preoperative score of 38 to 154 at eight weeks. No complications were documented.

Conclusion: This report documents what is believed to be the first published case of combined bilateral TKR with bilateral asymmetric intra-articular fracture fixation. Carefully selected elderly patients may benefit from this approach when performed by experienced surgical teams.

References

Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–1222. doi:10.1016/S0140-6736(20)30925-9

Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020;29–30:100587. doi:10.1016/j.eclinm.2020.100587

Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57–63. doi:10.1007/s11999-009-1119-9

Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–697. doi:10.1016/j.injury.2006.04.130

Papadopoulos EC, Parvizi J, Lai CH, Lewallen DG. Total knee arthroplasty following prior distal femoral fracture. Knee. 2002;9(4):267–274. doi:10.1016/S0968-0160(02)00020-2

Lonner JH, Pedlow FX, Siliski JM. Total knee arthroplasty for post-traumatic arthrosis of the distal femur. J Arthroplasty. 1999;14(8):969–975. doi:10.1016/s0883-5403(99)90007-3

Haidukewych GJ, Springer BD, Jacofsky DJ, Berry DJ. Total knee arthroplasty for salvage of failed internal fixation or nonunion of the distal femur. J Arthroplasty. 2005;20(3):344–349. doi:10.1016/j.arth.2004.09.042

Su ET, DeWal H, Di Cesare PE. Periprosthetic femoral fractures above total knee replacements. J Am Acad Orthop Surg. 2004;12(1):12–20. doi:10.5435/00124635-200401000-00004

Kolb W, Guhlmann H, Windisch C, Kolb K, Koller H, Grützner P. Total knee arthroplasty for the treatment of distal femoral fractures in elderly patients. J Trauma. 2010;68(1):38–45. doi:10.1097/TA.0b013e31819f3c55

Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e278S–e325S. doi:10.1378/chest.11-2404

Completo A, Fonseca F, Simões JA. Strain shielding in proximal tibia of stemmed knee prosthesis: experimental study. J Biomech. 2008;41(3):560–566. doi:10.1016/j.jbiomech.2007.10.006

Radnay CS, Scuderi GR. Management of bone loss: augments, cones, offset stems. Clin Orthop Relat Res. 2006;446:83–92. doi:10.1097/01.blo.0000214437.49525.78

Liu D, Wang H, Fu D, Chen J, Cao X. Meta-analysis of simultaneous bilateral versus staged bilateral total knee arthroplasty. J Arthroplasty. 2014;29(12):2438–2446. doi:10.1016/j.arth.2014.04.021