Naim Soulat, Toms Andrew D
Exeter Knee Reconstruction Unit, PEOC, Royal Devon & Exeter Hospital, Exeter, U.K.
Acta Orthop Belg. 2013 Apr;79(2):205-10.
Bone loss with large defects poses a complex and challenging problem in primary and revision knee arthroplasty. The defects are often irregular and difficult to quantify. One of the techniques available to restore bone in such cases is Knee Impaction Bone Grafting (KIBG); however, the clinical literature to support this technique is weak. Since 2006 we have used impaction bone grafting for contained and uncontained large tibial defects in primary and revision total knee arthroplasty. We have prospectively studied 11 patients with large tibial defects treated at the Exeter Knee Reconstruction Unit with KIBG using a short cemented stem following the Slooff-Ling philosophy. Average age was 66 years (41-86 years). Minimum follow-up was 2 years. The Knee Society Scores improved from 27.4 to 89.2 on average, with Knee Society Function score and WOMAC increasing by 263 and 23.2 points respectively. The mean post-operative flexion was 112 degrees. The average gain in motion over preoperative value was 20 degrees. At two years there were no mechanical failures. None of the patients have required secondary procedures or further revisions. All radiographs showed incorporation and remodelling of the graft. The only complication was a superficial dysaesthesia around the operative scar. Although being time consuming and technically demanding, KIBG for substantial tibial bone loss has shown excellent versatility and good short term results, providing a stable construct with immediate weight bearing post operatively. In view of previous concerns regarding early incorporation and stability of impaction bone grafting in the tibia, we present our early results at 2 years. This technique has become our preferred technique for treating substantial bone loss in tibial defects seen in primary and revision knee arthroplasty surgery.
在初次和翻修膝关节置换术中，存在大的骨缺损的骨丢失是一个复杂且具有挑战性的问题。这些缺损通常不规则且难以量化。在这种情况下，可用于恢复骨量的技术之一是膝关节打压植骨术（KIBG）；然而，支持该技术的临床文献较少。自2006年以来，我们在初次和翻修全膝关节置换术中，使用KIBG技术治疗包容性和非包容性的大的胫骨缺损。我们前瞻性地研究了11例在埃克塞特膝关节重建科接受KIBG治疗的大的胫骨缺损患者，采用了遵循斯洛夫-林理念的短柄骨水泥型假体。平均年龄为66岁（41 - 86岁）。最短随访时间为2年。膝关节协会评分平均从27.4分提高到89.2分，膝关节协会功能评分和WOMAC评分分别提高了263分和23.2分。术后平均屈曲角度为112度。与术前相比，平均活动度增加了20度。两年时无机械性失败病例。所有患者均未需要二次手术或进一步翻修。所有X线片均显示植骨融合和重塑。唯一的并发症是手术瘢痕周围的轻度感觉异常。尽管KIBG治疗大量胫骨骨丢失耗时且技术要求高，但已显示出出色的通用性和良好的短期效果，术后可立即负重并提供稳定的结构。鉴于之前对胫骨打压植骨早期融合和稳定性的担忧，我们展示了我们2年的早期结果。该技术已成为我们治疗初次和翻修膝关节置换手术中所见的胫骨缺损大量骨丢失的首选技术。
