Primary Total Knee Arthroplasty Using Revision-Type Stems for Distal Femoral Bone Compromise Following Previous Fracture Fixation: A Report of Two Cases and Narrative Review

Total knee arthroplasty (TKA) following previous distal femoral fracture treated with internal fixation presents unique surgical challenges due to altered metaphyseal anatomy, retained hardware, and compromised bone support that may persist despite fracture healing.We report two cases of primary TKA performed in patients with previous distal femoral fractures treated with osteosynthesis, in whom revisiontype stems were implanted in both the femoral and tibial components to optimize fixation in the setting of compromised bone quality while maintaining a primary polyethylene insert without increasing prosthetic constraint.The patients were 58 and 61 years old and were followed for six months.At six months, both patients demonstrated stable, well-aligned knees with favorable clinical outcomes, with Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12) scores of 54 and 58 and Single Assessment Numeric Evaluation (SANE) scores of 60% and 80%, respectively.Additionally, we present a narrative review addressing the use of stem extensions in primary TKA and the clinical scenarios in which they have been described.These cases illustrate individualized surgical decision-making in a poorly defined clinical scenario and demonstrate that revision-type stems may serve as a mechanical adjunct when residual distal femoral bone compromise following previous fracture fixation raises concerns regarding conventional fixation while allowing the preservation of primary prosthetic constraint.In selected patients with residual distal femoral bone compromise following previous fracture fixation, revision-type stems may provide a reasonable mechanical adjunct during primary TKA, supporting individualized implant selection.