Acetabular Screws With Cement Augment for Tibial Plateau Defects in Dynamic Spacer Implantation: A Case of Recalcitrant Native Knee Septic Arthritis.

Treating tibial bone defects in the setting of recalcitrant native knee arthritis presents a challenging biomechanical problem for orthopaedic surgeons. A dynamic antibiotic spacer offers an effective solution to preserve patient function and manage infection. However, severe bone loss may compromise the fixation of the dynamic spacer. We describe the application of acetabular screws as rebar in a case of an Anderson Orthopaedic Research Institute type 3 defect of the medial tibial plateau. Additionally, we outline a facile method for fabricating the tibial stem component to ensure optimal fit within the intramedullary canal. Short-term follow-up (8 months) indicates successful fixation of the tibial component, absence of knee pain, and a knee range of motion up to 100 degrees.

Free iliac crest grafting technology for the management of critical-sized tibial bone defect.

OBJECTIVE: To introduce the method and experience of treating critical-sized tibial bone defect by taking large iliac crest bone graft. METHODS: From January 2020 to January 2022, iliac crest bone grafting was performed in 20 patients (10 men and 10 women) with critical-sized tibial bone defect. The mean length of bone defect was 13.59 ± 3.41. Bilateral iliac crest grafts were harvested, including the inner and outer plates of the iliac crest and iliac spine. The cortical bone screw was used to integrate two iliac bone blocks into one complex. Locking plate was used to fix the graft-host complex, supplemented with reconstruction plate to increase stability when necessary. Bone healing was evaluated by cortical bone fusion on radiographs at follow-up, iliac pain was assessed by VAS score, and lower limb function was assessed by ODI score. Complications were also taken into consideration. RESULTS: The average follow-up time was 27.4 ± 5.6 (Range 24-33 months), the mean VAS score was 8.8 ± 1.9, the mean ODI score was 11.1 ± 1.8, and the number of cortical bone fusion in the bone graft area was 3.5 ± 0.5. Satisfactory fusion was obtained in all cases of iliac bone transplant-host site. No nonunion, shift or fracture was found in all cases. No infection and bone resorption were observed that need secondary surgery. One patient had dorsiflexion weakness of the great toe. Hypoesthesia of the dorsal foot was observed in 2 patients. Ankle stiffness and edema occurred in 3 patients. Complications were significantly improved by physical therapy and rehabilitation training. CONCLUSION: For the cases of critical-sized tibial bone defect, the treatment methods are various. In this paper, we have obtained satisfactory results by using large iliac bone graft to treat bone defect. This approach can not only restore the integrity of the tibia, but also obtain good stability with internal fixation, and operation skills are more acceptable for surgeons. Therefore, it provides an alternative surgical method for clinicians.

Transport over a flexible nail to treat a tibial defect caused by shelling injury: A case report of a 13-year-old child.

INTRODUCTION: The care of tibial traumatic fractures brought on by shelling injuries is extremely difficult, as these fractures are frequently comminuted, leading to a bone defect, extensive soft tissue damage, and an increased risk of bacterial contamination. CASE PRESENTATION: A 13-year-old male presented with trauma to the right leg following a shelling injury. He had a Gustilo IIIa open fracture with soft tissue destruction and a 7.5 cm bone loss in the distal region of the tibial shaft. Neurovascular exams were unremarkable. Primary treatment by external fixation, wound debridement, and simple suture closure was achieved. After the external fixator was removed, distraction osteogenesis was performed to deal with the bone loss. The surgical technique chosen was transport over a flexible intramedullary nail. By the end of both distraction and consolidation phases, the patient was healed with no complications, deformities, or length discrepancies. DISCUSSION: The objective of treating tibial shelling wounds is to restore functionality and save the patient's life and limb. Neurovascular evaluation, early bone fixation, and wound care are the basic treatment. Many techniques of distraction osteogenesis can be used to restore bone loss. With lower external fixation time and complications, transport over a nail is an important one. However, using a rigid intramedullary nail in children is contraindicated, so a flexible one was used. CONCLUSION: In this case report, we highlight the value of proper management of open leg fractures and the importance of restoring bone loss to improve the quality of life for war victims, particularly children.

Custom-Made Metaphyseal Sleeves in "Beyond" AORI III Defects for Revision Knee Arthroplasty-Proof of Concept and Short-Term Results of a New Technique.

BACKGROUND: While off-the-shelf cones and sleeves yield good results in AORI type 2 and 3 defects in revision knee surgery, massive longitudinal defects may require a proximal tibia replacement. To achieve the best anatomical as well as biomechanical reconstruction and preserve the tibial tuberosity, we developed custom-made metaphyseal sleeves (CMSs) to reconstruct massive defects with a hinge knee replacement. METHODS: Between 2019 and 2022, 10 patients were treated in a single-center study. The indication for revision was aseptic loosening in five cases and periprosthetic joint infection in five cases. The mean number of previous revisions after the index operations was 7 (SD: 2; 4-12). A postoperative analysis was conducted to evaluate the functional outcome as well as the osteointegrative potential. RESULTS: Implantation of the CMS in rTKA was carried out in all cases, with a mean operation time of 155 ± 48 (108-256) min. During the follow-up of 23 ± 7 (7-31) months, no CMS was revised and revisions due to other causes were conducted in five cases. Early radiographic evidence of osseointegration was recorded using a validated method. The postoperative OKS showed a significant increase (p < 0.001), with a mean score of 24 (SD: 4; range: 14-31). CONCLUSION: Custom-made metaphyseal sleeves show acceptable results in extreme cases. As custom-made components become more and more common, this treatment algorithm presents a viable alternative in complex rTKA.

Treatment of tibial large bone defects: A comparative study of bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate versus bone transport alone with antibiotic-impregnated calcium sulphate.

PURPOSE: To compare the bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate versus bone transport alone with antibiotic-impregnated calcium sulphate for the treatment of tibial large bone defects. METHODS: A retrospective analysis was conducted by enroling 33 surgically treated patients with tibial large bone defects after the debridement for tibial infection or osteomyelitis who were admitted in Lower Limb Surgery Ward of Traumatic orthopaedic Department, Xi'an Honghui Hospital from January 2018 to January 2021. All the patients were categorized in Group A (transport over intramedullary nail, 12 cases) and Group B (transport alone, 21 cases) based on the surgery strategy. The collected clinical materials and data included gender, age, injury mechanism, smoking habits, comorbidity diseases, initial fracture type (open or close), bone defect size, surgical duration, intraoperative bleeding loss, resorption time of calcium sulphate, bone transport time, external fixation time, external fixation index, weight bearing time, complications and Paley bone and functional criteria. RESULTS: Thirty-three patients were enroled and successfully followed up with an average time of 15.25±4.31 months ranged from 8 to 21 months in Group A and an average time of 17.09±5.64 months ranged from 9 to 31 months in Group B. No significantly statistical differences of the demographic data were discovered between the two groups. There were no significantly statistical differences of the average bone defect size, intraoperative bleeding loss, resorption time of calcium sulphate and bone transport time between the two groups. However, the average surgical duration (P = 0.002) was significantly longer in Group A than Group B and the average external fixation time (P<0.001), external fixation index(P = 0.002) and weight bearing time (P = 0.030) were significantly shorter in Group A than Group B. No significantly statistical difference of excellent and good rate of bone outcomes and complication rate was observed, however, the excellent and good rate of functional outcomes (P = 0.041) was significantly higher in Group A than Group B. CONCLUSION: Compared with the conventional Ilizarov technique combining with antibiotic-impregnated calcium sulphate for large tibial bone defects, bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate had favourable external fixation time, external fixation index, weight bearing time and clinical functional outcomes which effectively suppressed the infection and allowed patients earlier removal of the external fixator and weight bearing for rehabilitation.

Be alert to insidious fracture-related infections secondary to severe open fractures / 中华创伤骨科杂志

Objective:To report our experience in using the Ilizarov technique to treat bone defects secondary to Gustilo Ⅲb open tibial fractures with negative clinical signs and serological inflammatory markers.Methods:A retrospective study was performed to analyze the 19 patients with bone defects secondary to Gustilo Ⅲb open tibial fracture who had been treated at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital between January of 2010 and June of 2021. They were 15 males and 4 females with an age of (41±11) years. Their inclusion criteria: undergoing treatment with Ilizarov technique (consecutive compression-distraction or bone transport), soft tissue coverage procedures resulting in wound closure and negative clinical infection signs for at least 3 months and normal serological inflammatory markers, and follow-up for more than 3 months after frame removal. Three-phase bone scan was performed for the patients before the present surgery. Debridement, sampling of deep tissues for bacterial culture, and external stabilization with a fixator were performed in the present surgery. Osteotomy for compression-distraction or bone transport technique was carried out at 1 stage or 2 stages. Systemic antibiotic therapy for 6 weeks was continued for those with positive microbiological analysis guided by antibiogram. Recorded were results of intra-operative pus detection around defects, microbiological findings, length of bone defect reconstructed, rate and time of infection recurrence during treatment, fracture union rate, bone healing index, bony and functional results.Results:The interval between primary injury to the present surgery was (10±8) months. The preoperative three-phase bone scan showed infection free in 8 cases, chronic osteomyelitis in 7 cases, and suspicious infection in 4 cases. No pus was found during intra-operative debridement in all. The intra-operative microbiological detection was positive in 1 sample in 1 patient (infection free indicated by bone scan), and in ≥2 samples in 3 patients (bone scan indicating non-infection, infection not excluded and osteomyelitis in 1 case each). The length of bone defect reconstructed was (8±3) cm. The follow-up after the present surgery was (37±15) months. Fracture union was achieved in all cases, with a bone healing index of (1.7±0.5) months/cm. Clinical infection signs were observed 1 (1, 1) month after the present surgery in 6 patients whose microbiological results were all negative. All the 6 patients ended up with no clinical recurrence after empirical use of systemic antibiotics in 5 and radical debridement in one. The bony results showed 16 excellent and 3 good cases while the functional results showed 10 excellent and 9 good cases.Conclusions:In treatment of bone defects secondary to Gustilo Ⅲb open tibial fractures with negative clinical signs and serological inflammatory markers, constant vigilance is needed against low-grade infection. Intra-operative multiple sampling of deep tissues with a standardized protocol and microbiological testing are extremely valuable for diagnosis of fracture-related infections.

Using allogenous structural bone graft for uncontained tibial bone defects ≥ 10 mm in depth in primary total knee arthroplasty.

BACKGROUND: In primary total knee arthroplasty (TKA), tibial bone defects ≥ 10 mm in depth often become uncontained defects, a condition most surgeons find challenging to treat. Although the allogenous bone graft is a useful method, complications such as infection and nonunion are likely to occur. There are several reports on the use of allogenous bone graft in revision TKA; however, few studies have investigated its use in primary TKA. We performed primary TKA using the allogenous bone graft as a structural bone graft to treat uncontained defects ≥ 10 mm in depth. This study aimed to assess the clinical and radiographical results after primary TKA with allogenous structural bone graft (ASBG). METHODS: Seventeen patients (mean age, 69.2 years) with a follow-up period of at least 7 years, were retrospectively reviewed. All cases had been treated for medial bone defects using the ipsilateral medial tibial allogenous bone. Clinical evaluation included the assessment of the knee and function scores and knee angle, and the hip-knee-ankle (HKA) angle, bone union, and radiolucent line (RL) were assessed radiologically. RESULTS: The mean depth of the medial tibial defects after tibia cutting was 16.8 mm. Nonunion occurred in one case, and RL occurred in another. We observed a significant difference when the preoperative knee score and HKA angle of patients was compared with that at 1 year postoperatively and the final evaluation. No major complications were observed. CONCLUSION: The ASBG technique produced favorable surgical outcomes and may be an acceptable procedure for managing uncontained tibial bone defects ≥ 10 mm in depth in primary TKA.

Effect of Systemic Administration of Granulocyte-Colony Stimulating Factor on Rate of Fracture Healing of Bone Defect in Goats as Animal Model

@#Granulocyte-colony stimulating factor (G-CSF) serves as an important cytokine in haematopoiesis; released at both physiological and pathological conditions by a range of cells. We hypothesized that the systemic administration of G-CSF would produce an accelerated fracture-healing rate in non-union bone defects; thus, potentially leading to useful clinical applications. Ten male adult Katjang goats, weighing about 15-26 kilograms were randomly chosen and a tibial bone defect was induced in each animal. The defect was maintained by internal fixation with a titanium plate and reinforced by an external fiberglass cast. Post-operative radiographs were performed twice weekly and radiographic assessments were performed by evaluating the bridging and union measurements through a validated method. In the treatment group, the time for bridging and union exhibited statistically significant differences when compared with a control group. The outcomes of the present study establishing a notion that administration of G-CSF besides inducing haematopoiesis, promotes healing of fractures and non-union bone defects as well.

The efficacy of ilizarov method for management of long tibial bone and soft tissue defect.

INTRODUCTION: Patients with open fracture Gustillo-Anderson grade 3 had undergone several surgical procedures, but still ended up with expose long dead bone or infected. Illizarov method was used to address long bone and soft tissue defect after re-debridement with radical resection of long dead bone or infected segment. METHODS: We included 14 patients (mean age: 30.86 ± 11.49) with non-union tibial fracture with long dead and infected bone segment who had undergone several debridement, bone grafting or spacer and soft tissue closure procedure due to open fracture of tibia grade 3. The subjects underwent re-debridement with radical resection of dead or infected bone segment followed by Illizarov method to perform bone transport procedure for bone defect filling and simultaneously restore severe soft tissue loss and bone lengthening procedure. RESULTS: All subjects had achieved satisfactory results with mean docking period of bone transport 3.78 ± 0.54 months, union time at the docking side 7 (5.5-9) months. Soft tissue was covered and no recurrence of infection. Three subjects had Leg Length Discrepancy (LLD) of 1 cm, whereas the remaining had zero discrepancy. No significant pain was observed at final follow-up and 4 patients had ankle joint stiffness. CONCLUSION: The Illizarov method can effectively address long bone and soft tissue defects by distraction osteogenesis through bone transport procedure that filling the defect gradually without bone graft and simultaneously enhancing soft tissue closure without tertiary soft tissue procedure subsequently followed with bone lengthening procedure to correct the limb length discrepancy.

Treatment of 10-mm-Deep or Greater Uncontained Tibial Bone Defects in Primary Total Knee Reconstruction without Metal Augmentation: Autologous Oblique Structural Peg Bone and Cancellous Chip Bone Grafting.

BACKGROUD: In this study, we report satisfactory clinical and radiological outcomes after autologous oblique structural peg bone and cancellous chip bone grafting without metal augmentation, including the use of a metal wedge, block, or additional stem, for patients with ≥ 10-mm-deep uncontained medial proximal tibial bone defects in primary total knee replacement. METHODS: The study group included 40 patients with primary total knee replacement with ≥ 10-mm-deep uncontained tibial bone defects who underwent autologous oblique structural peg bone and cancellous chip bone grafting and were followed-up for at least 1 year. Tibial cutting was performed up to a depth of 10 mm from the articular surface of the lateral tibial condyle, after which the height and area of the remaining bone defect in the medial condyle were measured. The bone defect was treated by making a peg bone and chip bone using excised segments of the tibia and femur. In all cases, the standard tibial stem and full cemented fixation techniques were used without metal augmentation. Preoperative and final follow-up radiologic changes and clinical measures were compared, and prosthesis loosening and bone union were checked radiologically at final follow-up. RESULTS: The mean depth of the bone defects was 10.9 mm, and the mean percentage of the area occupied by bone defects in the axial plane was 18.4%. The mean mechanical femorotibial angle was corrected from 19.5° varus preoperatively to 0.2° varus postoperatively (p < 0.002). There was no prosthesis loosening, and all cases showed bone union at the 1-year postoperative follow-up. CONCLUSIONS: Even in patients with uncontained tibial bone defects ≥ 10-mm deep in primary total knee replacement, if the defect occupies less than 30% of the cut surface, autologous oblique structural peg bone and cancellous chip bone grafting can be used to achieve satisfactory outcomes with a standard tibial stem and no metal augmentation.

Injectable bone substitute based on chitosan with polyethylene glycol polymeric solution and biphasic calcium phosphate microspheres.

We described a method to produce an injectable bone substitute consisting of a solid and liquid phase, this solid was formed using the coacervation method consisting of a mixture of Hydroxyapatite (HAp) and beta-Tricalcium Phosphate (ß-TCP) which the sodium alginate - precursor - was removed during sinterization. The biphasic calcium phosphate microspheres had varying size distributions depending on the flow rate and these microspheres were mixed with a polymeric solution, chitosan and polyethylene glycol, and depending on the ratio of these phases, the injectability results varied. Nonetheless, the force required for complete removal will not disrupt the accuracy of injection into the bone defect while the biomaterial exhibited no cytotoxicity with promising results from in vivo using tibia bone defect in rabbits at 30 and 60 days whereas bone repair was more intense and accentuated with the usage of the biomaterial, and was gradually absorbed during the evaluated periods.

Complex bone and soft tissues defect reconstruction with a chimeric flap: Latissimus dorsi, serratus anterior and ribs: Case report.

Treatment of tibial defects with important soft tissue involvement after bilateral lower limb trauma are challenging for both orthopedic and plastic surgeons. Several therapeutic options are described in armamentarium of reconstructive surgeons such as bone grafts, bone substitutes, distractions osteogenesis, limb prosthesis, free flaps, negative pressure therapy and unfortunately amputation. We describe a patient with tibial and soft tissue defect reconstructed using a chimeric flap composed of latissimus dorsi, serratus anterior muscle and two ribs. At the 1-year follow-up the patient is able to walk with a walker and is still enrolled in rehabilitation program.

Correlation of tibial bone defect shape with patient demographics following total knee revision.

BACKGROUND: Bone defects of the proximal tibia following revision total knee arthroplasty (TKA) are challenging to manage, but must be addressed to provide lasting stability. This paper will categorize tibial bone defects into shape groups and correlate resulting groups to patient demographic data. METHODS: Retrospective analysis of four hundred and four patients post revision TKA between January 2005 and February 2014 was conducted. One hundred and eighteen met the inclusion criteria and were subcategorized by defect shape on their post-operative lateral and anterior-posterior (AP) radiographs. The subgroups of defect shape were subsequently analyzed with Fisher's exact test and one way ANOVA. RESULTS: Trapezoidal shaped defects were the most common in both radiographic views, and the magnitude of the defect at the top joint line varied significantly amongst shape groups in both AP and lateral views. Trapezoid shaped defects were correlated with smaller defect top lengths in both views. There was no statistical correlation between defect shape BMI, TIV and reason for revision in lateral view. However, T-bilateral defect shapes were correlated with higher BMIs in AP view. CONCLUSION: A volumetric classification system of tibial defects is necessary for preoperative planning in revision TKA. Common tibial bone defect shape groups were identified and analyzed in AP and lateral radiographs after revision TKA. Trapezoidal defects were the most common, and all other shapes followed a pattern of proximal enlargement tapering distally. Trapezoidal defects were smaller than other shapes and AP T-bilateral shaped defects were correlated with higher BMIs.

Relationship between Tibial Bone Defect and Extent of Medial Release in Total Knee Arthroplasty.

PURPOSE: To understand the relationship between tibial bone defect and extent of medial release in total knee arthroplasty. MATERIALS AND METHODS: We evaluated 32 knees in 22 patients with variable degrees of tibial bone defect on medial plateau has undergone total knee arthroplasty. In this study, 31 cases had been diagnosed as degenerative osteoarthritis and 1 case was osteonecrosis. We excluded cases with infection, traumatic arthritis, or neuropathic joints. With regard to gender, 29 cases were female and 3 cases were male. The following relationships were analyzed: preoperative degrees of tibial bone defect and varus deformity; the femorotibial angle of both weight-bearing whole extremity radiogram, distractive stress radiogram, and the extent of medial release. RESULTS: Average tibial bone defect was 9.8±4.1 mm. Average femorotibial angle on weight-bearing whole extremity radiograph was varus 10.0°±6.2°. Average femorotibial angle on distractive stress radiograph was varus 0.7°±4.6°. Statistically the extent of medial release showed no significant relationship with the degree of tibial bone defect and femoro-tibial angle of whole extremity radiogram. However, it revealed a statistically significant relationship with the femorotibial angle on distractive radiogram (r=0.465, p=0.007). CONCLUSIONS: Preoperative distractive stress radiograph might be a useful method to predict the extent of intraoperative medial release during total knee arthroplasty.

Relationship between Tibial Bone Defect and Extent of Medial Release in Total Knee Arthroplasty

PURPOSE: To understand the relationship between tibial bone defect and extent of medial release in total knee arthroplasty. MATERIALS AND METHODS: We evaluated 32 knees in 22 patients with variable degrees of tibial bone defect on medial plateau has undergone total knee arthroplasty. In this study, 31 cases had been diagnosed as degenerative osteoarthritis and 1 case was osteonecrosis. We excluded cases with infection, traumatic arthritis, or neuropathic joints. With regard to gender, 29 cases were female and 3 cases were male. The following relationships were analyzed: preoperative degrees of tibial bone defect and varus deformity; the femorotibial angle of both weight-bearing whole extremity radiogram, distractive stress radiogram, and the extent of medial release. RESULTS: Average tibial bone defect was 9.8+/-4.1 mm. Average femorotibial angle on weight-bearing whole extremity radiograph was varus 10.0degrees+/-6.2degrees. Average femorotibial angle on distractive stress radiograph was varus 0.7degrees+/-4.6degrees. Statistically the extent of medial release showed no significant relationship with the degree of tibial bone defect and femoro-tibial angle of whole extremity radiogram. However, it revealed a statistically significant relationship with the femorotibial angle on distractive radiogram (r=0.465, p=0.007). CONCLUSIONS: Preoperative distractive stress radiograph might be a useful method to predict the extent of intraoperative medial release during total knee arthroplasty.

Total knee arthroplasty for post-traumatic proximal tibial bone defect: three cases report.

Bone stock deficiency in primary as well as in revision total knee arthroplasty (TKA) represents a difficult problem to surgeon with regard to maintaining proper alignment of the implant components and in establishing a stable bone-implant interface. Different surgical procedures are available in these situations, for instances the use of bone cement, prosthetic augments, custom implant, and wire mesh with morsellized bone grafting and structural bone allograft. Structural allograft offers a numerous advantages as easy remodeling and felling cavitary or segmental defects, excellent biocompatibility, bone stock restoration and potential for ligamentous reattachment. In this article we report a short term result of three cases affected by severe segmental medial post/traumatic tibial plateau defect in arthritic knee, for which massive structural allograft reconstruction and primary total knee replacement were carried. The heights of the bone defect were between 27-33 mm and with moderate medio-lateral knee instability. Pre-operative AKS score in three cases was 30, 34 and 51 points consecutively and improved at the last follow-up to 83, 78 and 85 consecutively. No acute or chronic complication was observed. Last radiological exam referred no signs of prosthetic loosening, no secondary resorption of bone graft and well integrated graft to host bone. These results achieved in our similar three cases have confirmed that the structural bone allograft is a successful biological material to restore hemi-condylar segmental tibial bone defect when total knee replacement is indicated.

Early Full Weight Bearing after an Autogenous Structural Bone Graft for Treating a Medial Tibial Bone Defect in Total Knee Arthroplasty: Minimum 5 Years Follow up Results

PURPOSE: We evaluated the results of early full weight bearing after an autogenous bone graft and metal screw fixation of severe varus deformity with a medial tibial bone defect in total knee arthroplasty. MATERIALS AND METHODS: From August 1996 to March 2004, 34 patients (43 cases) were selected for the analysis. The average age was 68 and the mean follow up period was 72 month. The clinical results were evaluated using the knee range of motion and the Hospital for Special Surgery (HSS) score. The radiological results were evaluated using the tibiofemoral angle, the presence of loosening, radiolucent lines and osteolysis and the component's location. RESULTS: The mean HSS score increased from 46 to 87 points on the final follow up. The mean range of motion was increased from 71degrees to 118degrees on the final follow up. The mean femorotibial angle showed varus deformity angulation (23.5degrees) at pre-operative surgery, 6.2degrees valgus deformity for the first 7 postoperative days and 6.1 valgus at the last follow up. CONCLUSION: These findings suggest that an autogenous structural bone graft and metal screw fixation has fine results and makes early ambulation possible for the patient who has severe varus deformity with a medial tibial bone defect.

Autogenous Bone Graft with Bone peg for the Medial Tibial Bone Defect in Total Knee Arthroplasty

PURPOSE: The aim of this study is to report the usability of autogenous bone graft with bone peg in total knee arthroplasty in the patients with tibial medial bone defect from osteoarthritis due to severe varus deformity. MATERIALS AND METHODS: From July 1998 to December 2000, fifteen total knee arthroplasties with autogenous bone graft were performed for the medial tibial bone defects. The proximal tibia was resected and then bone pegs which were prepared from resected portion of distal femur and proximal tibia were inserted into the defect site with the shape of peg in the anterior posterior view using press fitting method. Instead of applying screw or K-wire, we performed press-fitting method for early stability. For attaining the stability, we preserved the sclerotic rim and designed precisely the bony defect site. We reviewed the result using the HSS Knee Rating Scale and observed the radiologic change. RESULTS: In HSS Knee Rating Scale review, 52.4 of preoperative score was improved to 84.7 at postoperative 1 year. Tibio-femoral angle , the average 17.8 degrees of varus was improved to the average 5.8 degrees of valgus at 1 year postoperatively. The average union period was 5 months, and there was no evidence of the displacement of grafted bone and loosening of the inserted implants. CONCLUSION: The method of autogenous bone graft applied with bone peg could be supposed as the stable fixation method without using screws or K-wires.

Autogenous Bone Graft with Perpendicular Screw Fixation of the Medial Tibial Bone Defect in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: We modified the Scuderi bone graft method for severely varus deformed patients, and then analyzed the clinical and radiological results and the changes of BMD at bone graft site. MATERIALS AND METHODS: Twenty-three total knee arthroplasties were performed in severely deformed varus knees. The proximal tibia was resected less than 10 mm thickness. In anteroposterior and tibial plateau view, defects was converted into a trapezoidal wedge shape for the self locking, and preserved anterior and posterior cortex. The defect was filled with an autogenous bone graft and fixed with two screws perpendicularly for early ambulation. RESULTS: The graft was completely united in 21 cases (90%) and the average of the union was 4 months postoperatively. The results were classified as excellent in 16 knees (70%) , good in 6 knees (26%) , and fair 1 knee (4%) using HSS knee rating scale. The average arc of motion was 115. and the tibio-femoral angle was 6.3. valgus. The BMD of bone graft site was checked 1.03 +/- 0.033 g/cm2 postoperatively and converted to 0.82 +/- 0.075 g/cm2 at follow-up 1 year. CONCLUSION: Modified autogenous bone graft could be preserved the subchondral bone essential for optimal thickness of cement and fixation of the tibial component.

Screw and Cement Fixation of Tibial Bone Defects in Total Knee Replacement

PURPOSE: To evaluate clinical and radiographic results for screw and cement fixation of tibial bone defect in total knee replacement arthroplasty(TKRA) retrospectively. MATERIALS AND METHODS: From march 1995 to May 1998, 23 total knee replacement arthroplasties were performed in 19 adults with screw and cement fixation for tibial bone defect. They were followed retrospectively for at least 12 months at mean 28 months(12~50). The average age of the patients at the time of operation was 64 years. The American Knee Society clinical rating system was used for the assessment of the results. We also used Knee Society roentgenographic evaluation and scoring system in all cases for assessment of radiolu-cent line between bone and cement interface, prothesis and cement, and around the threads of the screw within the bone. RESULTS: The average 37.6 preoperative knee rating score and 41 functional score were improved to 94.9 and 95 retrospectively at the last follow-up. Roentgenographic evalua- tion revealed that no radiolu-cent line was detected between prothesis and cement, around the threads of the screws within the bone. Between bone and cement interface, we observed radiolucent line in 8 of 23 cases(34.8%) and they had no progression during follow-up. CONCLUSIONS: Screw and cement fixation may be tried when tibial bone defect are small and situated peripherally. But, we considered that more long-term follow-up evaluation must be needed.