• Quanxiang Sun, Changjie Liu, Xuedong Sun, Zezhong Liu, Xiaoguang Liu, Wei Li, and Yimin Zhang.
• School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China.
• Medicine (Baltimore). 2024 Aug 23; 103 (34): e39382e39382.

RationalePeriprosthetic fractures (PPF) are rare complications of total knee arthroplasty (TKA). The most common PPF after TKA is supracondylar femoral fracture, which is a relatively rare complication that is usually associated with high-energy trauma, with a reported incidence ranging from 0.4 to 1.7% according to the AOANJRR. However, in TKA patients, it is rarer that the stress fracture around the tibial prosthesis occurs due to changes in the lower limb force line, increasing weight-bearing, and changes in walking gait.Patient ConcernsA 68-year-old woman visited our hospital with "both knees had aggravated pain and deformity for 8 years." TKA was performed first on the left knee and the patient was discharged within 1 week. Three months later, the patient complained of pain in the upper middle 1/3 part of the medial tibia for 2 weeks, which gradually worsened and affected weight-bearing.DiagnosesPhysical examination showed that the left knee joint presented varus deformity, and the right valgus deformity, which diagnosed as osteoarthritis of both knees and was so-called "blownknee". The disease was initially diagnosed as osteoarthritis of both knees on first admission and PPF of the tibia in second.InterventionsThree operations were performed on this patient. The first was TKA of the left knee, the second was open reduction and internal fixation of the PPF of the tibia 3 months after the first operation, and the third was TKA of the right knee.OutcomesUntil now, the patient has had no recurrent PPF, and the fracture is healing from the last X-ray.LessonsClinicians should be aware of the possibility of PPF after TKA, especially in such patients, the most preferred surgical treatment method was open reduction and internal fixation of fractures using locking plates, and if the PPF with loosened implants, Revision TKA, or megaprosthesis was the better choice.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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