Curative effect of structural bone grafting with extension stem for reconstructing tibial bone defect in primary total knee arthroplasty

Abstract

Objective To explore the curative of autologous bone graft combined with bone structure extension stem repair severe tibial bone defect on primary total knee arthroplasty(TKA) . Methods Data of 15 knees which existed severe varus and bone defect of tibia platform repaired and reconstructed the joint stability with autologous bone graft combined with the method of extension stem in primary TKA surgery from March 2010 to February 2015 in Department of Orthopaedics of Edong Healthcare Group, Huangshi Central Hospital were retrospectively analyzed. Four males and 11 females were included, the average age of the patients was 58 years old, ranging from 52 to 75 years. Genu varus angle was 17°-29°, an average of 26.2°±2.4. According to Knee Society score(KSS)criterion, the clinical score of preoperation was 20.4±7.2 and functional score was 21.3±8.5, 13 cases of Andersen Orthopaedic Research Institute(AORI)Ⅱ, 2 cases of AORI Ⅲ. Patients was used the cruciate ligament replacement prosthesis in TKA, by autologous bone graft combined with bone structure extension rod tibial prosthesis to repair the tibia bone defect, postoperative observation of genu varus angle, bone healing, bone graft displacement and prosthesis loosening, sinking, the KSS clinical score, and so on . Results All the 15 patients underwent successful operations. Operation time and volume of intraoperative blood loss were 65-80(72±6.3) min and 20-55(43±8.5) mL, respectively. All the patients were followed up for 10-32 months, the average follow-up time was 18.7±5.4 months. The KSS clinical scores were knee score 92.2±5.0 and functional score was 90.6±7.5 at the last follow-up. The KSS scores were paired by paired t-test, there was statistically significant difference(tclinical=42.138, tfunction=35.254, all P values<0.01). The X-ray measurement: genu varus angle was 5 °-9 °, an average of 7.6 °±1.3, structure blocks and platform tissue for the primary healing of bone graft. Bone graft blocks no shift, bone resorption, no prosthetic loosening, sinking, no joint infection, etc. Conclusions In primary TKA autologous bone graft combined with bone structure extension stem repair severe tibial bone defect, rebuild the stability of the knee joint, early clinical curative effect is satisfying. Key words: Arthroplasty, replacement, knee; Bone defect; Genu varum; Bone transplantation; Extension stem