An elderly woman underwent hardware removal and total joint replacement (TJR) of her right knee. Ipsilateral total tip replacement was performed 7 years earlier, and 12 months later, a supracondylar fracture of the index femur was successfully treated by open reduction internal fixation (ORIF) of the distal femur with a locking compression plate condylar plate. Hardware removal attempt, prior to the arthroplasty, resulted in fracture of the distal femur. Total knee replacement (TKR) was commenced with temporary reduction and final stabilisation of the femur fracture with a condylar plate. Postoperatively, non-union of the femur fracture developed twice with fatigue failure of the plate fixation device in both instances. Refixation of the femur was performed on both occasions and additional bone healing augmentation measures were performed for each subsequent surgery. Femur union was achieved fourteen months after the last surgery.

A 49-year-old man was involved in a high-energy motor vehicle accident. Haemodynamic instability with multiple long bone fractures of lower limbs was the hallmarks of the injury. Closed fragmented fracture of left femur shaft and open displaced supracondylar fracture of the contralateral femur. Closed comminuted high-grade fracture of the Tibia plateau (Schatzker VI) was diagnosed bilaterally. ‘Orthopaedic damage control’ was initiated with bilateral ‘cross knee’ external fixation, followed by conversion to open reduction internal fixation of all fracture sits at 8 days later. The patient underwent nine subsequent hospitalisations, of which eight involved operative treatment. The interval from admission to last documented surgery was 7 years. The endpoint was total knee arthroplasty (TKA) with mega prosthesis of the left knee and a primary-type TKA in the right knee. Both arthroplasties were non-assisted, conventional procedures. Postoperative Western Onterio and McMaster Universities Arthritis Index (WOMAC) score was 85 at 9-year follow-up from the injury incurred.