Using Tibia Proximal Cut Autograft in Advanced Varus Knee Deformity in Total Knee Arthroplasty; Outcomes Compared to the Control Group

Abstract

Background:The purpose of this study was to compare the outcomes of Total Knee Arthroplasty (TKA) performed for advanced varus knee deformity, which is performed by using tibia proximal cut bone for the reconstruction of the tibia proximal medial bone defects, with a control group consisting of TKAs which did not need reconstruction.Methods:Patients in the present study underwent total knee arthroplasty between 2009 and 2015. 12 patients with advanced varus deformity who had undergone reconstruction with tibia proximal cut autograft and 15 patients who were randomly selected from patients who did not need reconstruction, were compared clinically and radiographically.Results:The mean follow-up period of the patients was found to be 73.1 ± 19.7 (36-108) months in the reconstruction group and 73.2 ± 12.3 (39-107) months in the control group. (p> 0.05) In both groups, significant improvement was observed postoperatively. In both groups, there was no evidence of loosening the required revision. WOMAC score was 32.4 ± 13.3 (8-64) in the reconstruction group and 28.9 ± 17.2 (6-70) in the control group at the last control visit. There was no difference between the groups when comparing the WOMAC scores at the last control visit. In the reconstruction group, the Hip-Knee-Ankle (HKA) angle was 26.1 ± 4.9 ° varus preoperatively and 1.3 ± 2.3 ° valgus postoperatively; and in the control group 10.1 ± 2.1 ° varus preoperatively and 2.7 ± 3.4 ° valgus postoperatively. (p> 0.05)Conclusion:In the present study, clinical and radiographic results of total knee arthroplasty patients, who suffered from advanced knee varus deformity and whose proximal tibia medial defects were reconstructed by using tibial proximal cut autograft, have been found to be successful when compared to the control group.

Autogenous structural bone graft reconstruction of ≥ 10-mm-deep uncontained medial proximal tibial defects in primary total knee arthroplasty

“…In the standard tibial component of TKA, 53–67% of load sharing occurs at the cortical rim [ 24 ]. Thus, uncontained defects without cortical support must be addressed adequately to ensure prosthesis stability [ 25 ].…”

Colocación de autoinjerto estructural para defecto óseo tibial medial en artroplastia total de rodilla. Reporte de un caso y revisión de la literatura

“…de movimiento o angulación en eje mecánico, con resultados buenos a excelentes en ambos grupos, sin encontrar complicaciones relacionadas con la reconstrucción con injerto autólogo. 16 Kharbanda y su grupo realizaron un análisis retrospectivo de 54 rodillas en 34 pacientes sometidos a artroplastia total de rodilla primaria con deformidad severa en varo que requirieron injerto autólogo para reconstrucción tibial por defectos > 5 mm posterior a corte convencional y angulación en varo promedio de 28 o , con seguimiento promedio de 7.8 años, encontrando integración completa de injerto en todos los pacientes a los 4.5 meses en promedio, con resultados buenos a excelentes en escala de WOMAC y Knee Society Score, sin complicaciones tales como reabsorción de injerto, aflojamiento de componentes por efecto de batería (reacción electroquímica que se produce al realizarse contacto entre dos metales) o aflojamiento de tornillos. 8 En el caso aquí reportado, se utilizó injerto autólogo proveniente del corte de chaflán anterior femoral para la reconstrucción tibial medial, el cual se fijó con tornillos de esponjosa de 4.0 mm, sin encontrar datos de reabsorción, aflojamiento o fragmentación en un seguimiento temprano de ocho semanas, con mejoría significativa de sintomatología y aumento de funcionalidad (Figuras 10 a 12).…”