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

• Chon JG
• Song IS
• Kim JB
• Jang GI
• Ahn CH
• Yoon JY

• KMID: 2421344
• DOI: http://doi.org/10.4055/jkoa.2017.52.6.514

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

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

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  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).

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  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.

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  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).

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