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Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees.

Abstract：

BACKGROUND:Large posteromedial defects encountered in severe varus knees during primary total knee arthroplasty can be treated by cementoplasty, structural bone grafts or metallic wedges. The option is selected depending upon the size of the defect. We studied the outcome of autograft (structural and impaction bone grafting) reconstruction of medial tibial bone defects encountered during primary total knee replacement in severe varus knees. MATERIALS AND METHODS:Out of 675 primary varus knees operated, bone defects in proximal tibia were encountered in 54 knees. Posteromedial defects involving 25-40% of the tibial condyle cut surface and measuring more than 5 mm in depth were grafted using a structural graft obtained from cut distal femur or proximal tibia in 48 knees. For larger, peripheral uncontained vertical defects in six cases, measuring >25 mm in depth and involving >40% cut surface of proximal tibial condyle, impaction bone grafting with a mesh support was used. RESULTS:Bone grafts incorporated in 54 knees in 6 months. There was no graft collapse or stress fractures, loosening or nonunion. The average followup period was 7.8 years (range 5-10 years). We observed an average postoperative increase in the Knee Society Score from 40 to 90 points. There was improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in terms of pain, stiffness and physical function during activities of daily living. CONCLUSION:Bone grafting for defects in primary total knee is justified as it is biological, available then and is cost effective besides preserving bone stock for future revisions. Structural grafts should be used in defects >5 mm deep and involving 25-40% of the cut proximal tibial condyle surface. For larger peripheral vertical defects, impaction bone grafting contained in a mesh should be done.

journal_name

Indian J Orthop

journal_title

Indian journal of orthopaedics

authors

Kharbanda Y,Sharma M

doi

10.4103/0019-5413.132525

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

313-8

issue

eissn

0019-5413

issn

1998-3727

pii

IJOrtho-48-313

journal_volume

pub_type

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Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees.