56  yr old lady with stiff knee post patellectomy 20 year ago for an infected patelar fracture  post fixation presented with fracture proximal tibia with bi compartmental arthritis. no infection. Normal ESR/ CRP and normal scar  works as a govt employee living in a women’s hostel and need to climb into a bus

Problems

(pre fracture ROM 10 to 30), 

porotic bone

 ? bugs

financially challenged

 Options

 1. Fixation first with or without cultures

     and second stage tkr

 2 one stage Arthrolysis,Replacement and fixation  

sequence of surgery

 Mid line incision perpendicular to previous transverse incision

 Supra patellar  and gutter scar release. 

 Distal femoral standard resection. cruciate ligaments removed to get tibial intra
medullary access

 Intra medullary tibial jig for  tibial  resection.

 Stemmed tibia to bypass fracture and augmentation with a l medial MIPO tibial plate. graft the   Fracture site with cancelous graft from cut  surface. immediate passive flexion tom 90 obtained  

 and NWB ROM  for 4 weeks

3 months postop