Abstract
Purpose
This study reports a case series of 44 primary total knee arthroplasties (TKAs) using autogenous morcellised bone grafting for large (≥10-mm-deep) medial tibial defects, which are generally repaired using metal augmentation. The bone-grafting technique is described in detail and the radiological outcomes are presented.
Methods
A total of 44 TKAs were followed up for a mean period of 58 months (range 24–139 months). Multiple drill holes were made in the sclerotic floor of the defect, followed by the impaction of morcellised cancellous bone grafts to fill the defects. Tibial components were fixed using the cemented or noncemented technique and no internal fixation devices were used. Stem extension of the tibial component was only used in one TKA.
Results
Radiograms revealed that the grafted bone was completely incorporated into the host bone within one year post-operatively. No grafted bone absorption or collapse was detected. A clear zone between the tibial component and grafted bone was observed in six knees, but it did not become enlarged thereafter.
Conclusions
The presented technique provided favourable radiological outcomes and had several advantages: (1) it enables preservation of as much bone as possible for future revision surgery; (2) it is cost effective and simple because metal augments, internal fixation devices and stem extension are not needed; (3) it can be used in the same manner any defect to a depth ≥3 mm. Thus, this is an acceptable and reproducible alternative technique.
Similar content being viewed by others
References
Callaghan JJ, Wells CW, Liu SS, Goetz DD, Johnston RC (2010) Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of twenty years, of a previous report. J Bone Joint Surg Am 92(7):1635–1639
Gill GS, Joshi AB, Mills DM (1999) Total condylar knee arthroplasty: 16- to 21- year results. Clin Orthop Relat Res 367:210–215
Ranawat CS, Flynn WF Jr, Saddler S, Hansraj KK, Maynard MJ (1993) Long-term results of the total condylar knee arthroplasty: a 15-year survivorship study. Clin Orthop Relat Res 286:94–102
Victor J, Ghijselings S, Tajdar F, Van Damme G, Deprez P, Arnout N, Van Der Straeten C (2014) Total knee arthroplasty at 15–17 years: does implant design affect outcome? Int Orthop 38(2):235–241
Lotke PA, Wong RY, Ecker ML (1991) The use of methylmethacrylate in primary total knee replacements with large tibial defects. Clin Orthop Relat Res 270:288–294
Ritter MA, Keating EM, Faris PM (1993) Screw and cement fixation of large defects in total knee arthroplasty: a sequel. J Arthroplasty 8(1):63–65
Aglietti P, Buzzi R, Scrobe F (1991) Autologous bone grafting for medial tibial defects in total knee arthroplasty. J Arthroplasty 6(4):287–294
Ahmed I, Logan M, Alipour F, Dashti H, Hadden WA (2008) Autogenous bone grafting of uncontained bony defects of tibia during total knee arthroplasty: a 10-year follow up. J Arthroplasty 23(5):744–750
Altchek D, Sculco TP, Rawlins B (1989) Autogenous bone grafting for severe angular deformity in total knee arthroplasty. J Arthroplasty 4(2):151–155
Dorr LD, Ranawat CS, Sculco TA, McKaskill B, Orisek BS (1986) Bone graft for tibial defects in total knee arthroplasty. Clin Orthop Relat Res 205:153–165
Mullaji AB, Padmanabhan V, Jindal G (2005) Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20°. J Arthroplasty 20(5):550–561
Engh GA, Herzwurm PJ, Parks NL (1997) Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty. J Bone Joint Surg Am 79(7):1030–1039
Harris AI, Poddar S, Gitelis S, Sheinkop MB, Rosenberg AG (1995) Arthroplasty with a composite of an allograft and a prosthesis for knees with severe deficiency of bone. J Bone Joint Surg Am 77(3):373–386
Brand MG, Daley R, Ewald FC, Scott RD (1989) Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency. Clin Orthop Relat Res 248:71–79
Hamai S, Miyahara H, Esaki Y, Hirata G, Terada K, Kobara N, Miyazaki K, Senju T, Iwamoto Y (2015) Mid-term clinical results of primary total knee arthroplasty using metal block augmentation and stem extension in patients with rheumatoid arthritis. BMC Musculoskelet Disord 16:225–230. doi:10.1186/s12891-015-0689-9
Lee JK, Choi CH (2011) Management of tibial bone defects with metal augmentation in primary total knee replacement: a minimum five-year review. J Bone Joint Surg (Br) 93(11):1493–1496
Pagnano MW, Trousdale RT, Rand JA (1995) Tibial wedge augmentation for bone deficiency in total knee arthroplasty: a followup study. Clin Orthop Relat Res 321:151–155
Tsukada S, Wakui M, Matsueda M (2013) Metal block augmentation for bone defects of the medial tibia during primary total knee arthroplasty. J Orthop Surg Res 8:36–41. doi:10.1186/1749-799X-8-36
Vail TP, Lang JE, Sikes CV (2012) Surgical techniques and instrumentation in total knee arthroplasty. In: Scott WN (ed) Insall & Scott surgery of the knee, 5th edn. Churchill Livingstone, New York, pp 1042–1099
Watanabe W, Sato K, Itoi E (2001) Autologous bone grafting without screw fixation for tibial defects in total knee arthroplasty. J Orthop Sci 6(6):481–486
Panegrossi G, Ceretti M, Papalia M, Casella F, Favetti F, Falez F (2014) Bone loss management in total knee revision surgery. Int Orthop 38(2):419–427
Rawlinson JJ, Closkey RF Jr, Davis N, Wright TM, Windtsor R (2008) Stemmed implants improve stability in augmented constrained condylar knees. Clin Orthop Relat Res 466:2639–2643
Kharbanda Y, Sharma M (2014) Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees. Indian J Orthop 48(3):313–318
Sugita T, Aizawa T, Sasaki A, Miyatake N, Fujisawa H, Kamimura M (2015) Autologous morselised bone grafting for medial tibial defects in total knee arthroplasty. J Orthop Surg 23(2):185–189
Hanna SA, Aston WJS, de Roeck NJ, Gough-Palmer A, Powles DP (2011) Cementless revision TKA with bone grafting of osseous defects restores bone stock with a low revision rate at 4 to 10 years. Clin Orthop Relat Res 469:3164–3171
Toms AD, McClelland D, Chua L, de Waal Malefijt M, Verdonschot N, Jones RS, Kuiper J-H (2005) Mechanical testing of impaction bone grafting in the tibia: initial stability and design of the stem. J Bone Joint Surg (Br) 87(5):656–663
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
There is no funding source.
Ethical approval
Not required.
Informed consent
Informed consent was obtained from all participants.
Rights and permissions
About this article
Cite this article
Sugita, T., Aizawa, T., Miyatake, N. et al. Preliminary results of managing large medial tibial defects in primary total knee arthroplasty: autogenous morcellised bone graft. International Orthopaedics (SICOT) 41, 931–937 (2017). https://doi.org/10.1007/s00264-016-3339-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-016-3339-4