Autogeneous bone graft in the treatment of total knee arthroplasty for severe genu varus with tibial plateau bone defect

To introduce the method and experience of autogeneous bone graft for tibial plateau reconstruction during the procedure of total knee arthroplasty for severe varus knees with bone defect in the medial tibial plateau.From April 2007 to March 2011, 19 knees of 16 osteoarthritic patients who had serious genu varus with bone defect in medial tibial plateau underwent primary total knee arthroplasty, their mean varus degree being 32° (25°to 45°), and average age 66±8 years (52 to 77 years). Their preoperative knee functions are as follows: the average range of motion (ROM) was 62°(37° to 90°); average knee society scure(KSS) knee score was 18 points (-24 to 41 points); average function score was 13 points (-21 to 43 points). During operation, the slope bone defect of the medial tibial plateau was dressed into step-shape horizontal bone defect by osteotomy, and then the defect was restored with the resected tibial plateau autograft whose thickness and shape were matched in advance; and the high-intensity cortical part of the autograft was placed on the rim, to sustain the tibial prosthesis; and a lateral pressure from the rim had to be maintained to the autograft until the cement under tibial prosthesis solidified. The long-stem tibial prostheses were used in 3 patients ( 3 knees ). All knee prostheses were fixed using antibiotic bone cements.The average follow-up after TKR was 25 months (3 to 50 months), the average ROM was 112° (95° to 125°); average KSS score 86 points (71 to 93 points), and knee function score 88 points ( 74 to 96 points). The nonunion, shift, fracture of the autologous graft bone were not found; no tibial prosthesis became loose, either; no knee was revised for delayed infection or recurrent varus due to autologous graft bone absorption.In TKA for severe varus osteoarthritic patients with bone defect in the tibial plateau, there are various ways to regain its stability, and reconstruction is adopted by using step-shape allograft in this paper. This method can not only restore the integrity of the tibial plateau, providing good initial stability of the prostheses, and exempting from internal fixations, but also offer more reliable compatibility than other methods, reducing postoperative infection rates, and obtaining satisfied initial curative effect.PubMed05707-134