Knee Osteoarthritis with Old Untreated Patella Fracture Treated with Single Stage Total Knee Arthroplasty - A Case Series of Two Cases

INTRODUCTION: Total knee arthroplasty (TKA) is one of the most successful procedures for osteoarthritis (OA), but when associated with an old patella fracture, the knee arthroplasty becomes complex due to discontinuity in extensor mechanism. Moreover, in elderly patients, early mobilization and avoiding multiple surgeries are important to prevent associated morbidity. This is the first instance of a case series being reported where an untreated patella fracture >3-months-old with knee OA has been managed with single stage TKA. CASE REPORT: Two patients, both with OA of knee and untreated patellar fractures, presented to us with knee pain. A 74-year-old lady having 6-months-old untreated right patella fracture without extensor lag was our first patient and a 57-years-old lady having 2-years-old patella fracture non-union with extensor lag of 30° was our second patient. Both were assessed and a decision to perform total knee replacement was taken. Patient with extensor lag required reconstruction of the extensor mechanism whereas the one without extensor lag was treated as a normal routine total knee replacement. CONCLUSION: Elderly patients with untreated patella fracture and degenerative knee OA can be considered for single stage TKA, with decision on patella management based on the presence or absence of extensor lag. Rehabilitation is faster with single surgery and also there are decreased risks and complications associated with multiple surgeries.