Difficult primary knees are fairly common in Asian countries, and tibial stress fractures in deformed osteoarthritic knees add to the challenge. Management options are ill-defined because of limited experience; for 5 years, 8 osteoarthritic knees with extra-articular tibial stress fractures ranging from unicortical stress lesions to frankly mobile fractures were managed by total knee arthroplasty. At mean 42.25 months follow-up, average Knee Society Score improved from 23.62 to 80.87; and average functional score improved from 18.75 to 67.75. All 8 fractures united; 1 (plate plus stem extender) had wound breakdown and delayed union. We present our learning experience with single-stage modular total knee arthroplasty using stem extenders or plates; with proper planning and additional use of image intensifier, these unique cases can reliably be managed with satisfactory outcomes.
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