Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea.
Clin Orthop Surg. 2021 Jun;13(2):168-174. doi: 10.4055/cios20079. Epub 2021 Mar 9.
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.
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.
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 ( < 0.002). There was no prosthesis loosening, and all cases showed bone union at the 1-year postoperative follow-up.
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.
在这项研究中，我们报告了在初次全膝关节置换中，对于≥10mm 深部非包容性内侧胫骨骨缺损患者，不使用金属增强物（包括金属楔形物、块或额外的柄）进行自体斜向结构钉骨和松质骨屑骨移植后的满意临床和影像学结果。
研究组包括 40 例初次全膝关节置换术伴≥10mm 深部非包容性胫骨骨缺损患者，行自体斜向结构钉骨和松质骨屑骨移植，并至少随访 1 年。胫骨切割至外侧胫骨髁关节面以下 10mm 深度，然后测量内侧髁剩余骨缺损的高度和面积。使用切除的胫骨和股骨段制作钉骨和骨屑来治疗骨缺损。所有病例均采用标准胫骨柄和全水泥固定技术，不使用金属增强物。比较术前和最终随访的影像学变化和临床测量结果，并在最终随访时行影像学检查以确定假体松动和骨愈合情况。
骨缺损的平均深度为 10.9mm，轴向平面骨缺损面积的平均百分比为 18.4%。平均机械股骨胫骨角从术前的 19.5° 内翻矫正至术后的 0.2° 内翻（<0.002）。无假体松动，所有病例在术后 1 年随访时均显示骨愈合。
即使在初次全膝关节置换中，对于≥10mm 深部非包容性胫骨骨缺损患者，如果缺损面积小于切骨面的 30%，可以使用自体斜向结构钉骨和松质骨屑骨移植，采用标准胫骨柄和不使用金属增强物也可以获得满意的结果。
