ABSTRACT
[Abstrct] Objective The deformity of severe varus knee (varus angulation > 15°) can be treated by many ways in primary total knee arthroplasty , but the efficacy and cost are different. The topic of this study provides a new surgery: autograft (wedge grafts) implant and substitute medial tibial bone defects. Methods From Jan. 2006 to Jan. 2014 , a retrospective study was conducted in the First Affiliated Hospital of BaoTou Mendical College. Out of 687 patients, 721 primary knees were operated. Bone defects in proximal tibia (varus angulation >15° ) were encounted in 16 patients in 21 knees in the pattern of non-inclusive slope bone defects in the mean varus degree of 27°. Their IBM was 31 kg/m2. The average age of patients was (63 ± 5) years. The score of clinical knee society score (KSS) before operation was 18 on average. Among of them, the pain score were 12 points, the average range of motion (ROM) were 12 points. the average funtional score were 20 points. During operation,the slope bone defect of the medial tibial plateau was tailored into wedge-shaped ladder bone defect by osteotomy,and then the defect was filled with the resected tibial plateau autograft in which the thickness and shape were matched completely. The high-intensity cortical part of the autograft was placed in the rim to sustain the tibial prosthesis. Three months after operation ,patients started to walk without the help of crutch. Results The average followup period was 5.3 y , We observed that an average postoperative scores of clinical KSS from 42 points to 88 points with the score of functional KSS from 57 points to 92 points. Fusion was observed by trabeculae crossing from the graft to the tibial metaphysis on plain films at least 6 mouths without collapse, stress fracture, untight and bone ununion. Confirmation of vascularization of the graft was observed in bone scans of nuclide. showing increased uptake in the operated area. Inflammatory makers were normal. Conclusion Autograft (wedge grafts) reconstruction of medial tibial bone defects, is of high rate of healing in implant bones, good restoration of the function and low cost.