J Korean Orthop Assoc.  2017 Dec;52(6):514-520. 10.4055/jkoa.2017.52.6.514.

The Effects of Autologous Structural Bone Graft without Internal Fixation on Posteromedial Tibial Bone Defect in Primary Total Knee Arthroplasty

Affiliations
  • 1Department of Orthopedic Surgery, Daejeon Sun Hospital, Daejeon, Korea. mydangjang@naver.com

Abstract

PURPOSE
To evaluate the radiological and clinical outcomes of the standard total knee arthroplasty without internal fixation or extended long stem in tibial bone defect with severe varus deformity.
MATERIALS AND METHODS
Between July 2012 and April 2014, 32 patients (45 cases; 4 men and 41 women with a mean age of 74.2 years) who underwent total knee arthroplasty with autologous bone grafting were enrolled for analysis. The mean follow-up period was 34.4 months. The cancellous bone defect site was exposed, and a longitudinal sulcus was made. Subsequently, a premolded bone graft was inserted in the sulcus at 45°. The defect size was measured, and the radiological and clinical results were evaluated.
RESULTS
The mean defect size according to the radiograph was found to be 15.31×30.36 mm in the frontal view and 15.46×45.98 mm in the sagittal view. The mean defect size of depth during the operation was found to be 8.38 mm. The preoperative mean varus angle was 14.1° (4.0°-26.9°), and the follow-up mean valgus angle was 5.4° (0.5°-10.5°). The implant position was α=95.7°, β=90.4°, γ=2.1°, δ=89.1° on the follow-up. No implant loosening was observed, and the mean bone union period was 4.3 months. The Hospital for Special Surgery score was improved from a preoperative mean of 50.1 to a postoperative mean of 90.4.
CONCLUSION
Standard total knee arthroplasty using autologous structural bone grafting without internal fixation in a tibial bone defect demonstrated a rapid, stable bone healing and excellent radiological and clinical results. Thus the index procedure was considered to be simple, and effective for bone grafting.

Keyword

knee arthroplasty; bone grafting

MeSH Terms

Arthroplasty, Replacement, Knee*
Bone Transplantation
Congenital Abnormalities
Female
Follow-Up Studies
Humans
Male
Transplants*

Figure

  • Figure 1 We measured the tibial bone defect by preoperative radiograph.

  • Figure 2 These photographs of an 81-year-old female patient show posteromedial bone defect of the proximal tibia. After resecting the proximal tibial bone, we measured the depths and widths of bone defect with a ruler. We marked line for the tibial implant (arrows).

  • Figure 3 (A) We made an antero-posterior sulcus with burr for grafted bone insertion. (B) We made a longitudinal sulcus and prepared the decorticated bone from the resected bone fragment. (C) Premolded autograft bone was inserted into the longitudinal sulcus at 45°. (D) We cut the autogenous structural bone using saw at the level of the resected proximal tibia. (E) We impacted the cancellous bone in the other bone defect site.

  • Figure 4 These radiographs of an 81-year-old female patient. (A) Preoperative radiograph shows varus deformity with a large bone defect. (B) Postoperative radiograph shows that the grafted bone was sclerotic immediately and clearly (arrow). (C) Follow-up radiograph in postoperative 3 months showed bony union with bone trabeculae crossing from the grafted bone to the host bone (arrow).


Cited by  1 articles

External Tibial Torsion with Proximal Tibia Vara in Total Knee Arthroplasty of Advanced Osteoarthritis with Severe Varus Deformed Knees
Doo-Hoon Sun, In-Soo Song, Jun-Beom Kim, Cheol-U Kim, Deukhee Jung, Uitak Jeong
J Korean Orthop Assoc. 2020;55(1):62-70.    doi: 10.4055/jkoa.2020.55.1.62.


Reference

1. Lotke PA, Wong RY, Ecker ML. The use of methylmethacrylate in primary total knee replacements with large tibial defects. Clin Orthop Relat Res. 1991; 270:288–294.
Article
2. Ritter MA, Keating EM, Faris PM. Screw and cement fixation of large defects in total knee arthroplasty. A sequel. J Arthroplasty. 1993; 8:63–65.
3. Brand MG, Daley RJ, Ewald FC, Scott RD. Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency. Clin Orthop Relat Res. 1989; 248:71–79.
Article
4. Pagnano MW, Trousdale RT, Rand JA. Tibial wedge augmentation for bone deficiency in total knee arthroplasty. A followup study. Clin Orthop Relat Res. 1995; 321:151–155.
5. Cho WS, Kim CH, Park CJ. Augmentation of tibial bony defect with metal wedge and block in primaryTKA. J Korean Orthop Assoc. 1999; 34:50–56.
6. Harris AI, Poddar S, Gitelis S, Sheinkop MB, Rosenberg AG. Arthroplasty with a composite of an allograft and a prosthesis for knees with severe deficiency of bone. J Bone Joint Surg Am. 1995; 77:373–386.
Article
7. Engh GA, Herzwurm PJ, Parks NL. Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty. J Bone Joint Surg Am. 1997; 79:1030–1039.
Article
8. Altchek D, Sculco TP, Rawlins B. Autogenous bone grafting for severe angular deformity in total knee arthroplasty. J Arthroplasty. 1989; 4:151–155.
Article
9. Laskin RS. Total knee arthroplasty in the presence of large bony defects of the tibia and marked knee instability. Clin Orthop Relat Res. 1989; 248:66–70.
Article
10. Aglietti P, Buzzi R, Scrobe F. Autologous bone grafting for medial tibial defects in total knee arthroplasty. J Arthroplasty. 1991; 6:287–294.
Article
11. Mullaji AB, Padmanabhan V, Jindal G. Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplasty. 2005; 20:550–561.
12. Ahmed I, Logan M, Alipour F, Dashti H, Hadden WA. Autogenous bone grafting of uncontained bony defects of tibia during total knee arthroplasty a 10-year follow up. J Arthroplasty. 2008; 23:744–750.
13. Cameron HU, Turner DG, Cameron GM. Results of bone grafting of tibial defects in uncemented total knee replacements. Can J Surg. 1988; 31:30–32.
14. Scuderi GR, Insall JN, Haas SB, Becker-Fluegel MW, Windsor RE. Inlay autogeneic bone grafting of tibial defects in primary total knee arthroplasty. Clin Orthop Relat Res. 1989; 248:93–97.
Article
15. Dorr LD, Ranawat CS, Sculco TA, McKaskill B, Orisek BS. Bone graft for tibial defects in total knee arthroplasty. Clin Orthop Relat Res. 1986; 205:153–165.
Article
16. Vail TP, Lang JE, Sikes CV. Surgical techniques and instrumentation in total knee arthroplasty. In : Scott WN, editor. Insall & Scott surgery of the knee. 5th ed. New York: Churchill Livingstone;2012. p. 1042–1099.
17. Windsor RE, Insall JN, Sculco TP. Bone grafting of tibial defects in primary and revision total knee arthroplasty. Clin Orthop Relat Res. 1986; 205:132–137.
Article
18. Watanabe W, Sato K, Itoi E. Autologous bone grafting without screw fixation for tibial defects in total knee arthroplasty. J Orthop Sci. 2001; 6:481–486.
Article
Full Text Links
  • JKOA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr