Autogenous Bone Grafting of Uncontained Bony Defects of Tibia During Total Knee Arthroplasty

Ahmed, Issaq; Logan, Martin; Alipour, Faz; Dashti, Hassan; Hadden, W.A.

doi:10.1016/j.arth.2007.08.021

Cited by 22 publications

(21 citation statements)

References 22 publications

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“…In most cases, the bone graft was rigidly fixed with cannulated cancellous screws. Although some reports have described wire fixation 16 and screwless fixation, 15 in the current study, screws were used to achieve rigid initial fixation. The strength of this fixation can be tested under the mechanical forces associated with insertion of the implant keel.…”

Section: Discussionmentioning

confidence: 89%

“…Although Laskin 12 reported only a 67% success rate, subsequent studies showed better results. [13][14][15][16] In a study of 54 cases, all achieved bone union, but the length of the stem and the type of prosthesis varied between cases. 19 Differences in implants can change the stress within the tibia and significantly affect the union between the graft and recipient bone.…”

Section: Discussionmentioning

confidence: 99%

“…10 The union rate for this procedure in primary TKA is not well known because few studies have been performed, the number of cases was limited, and most procedures were revised TKA. [11][12][13][14][15][16] Other unknown factors include long-term maintenance of postoperative alignment, the degree of correction achieved, the clinical outcome, and associated complications. To answer these questions, a retrospective evaluation of results with autologous bone graft in primary TKA was performed.…”

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confidence: 99%

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Union, Knee Alignment, and Clinical Outcomes of Patients Treated With Autologous Bone Grafting for Medial Tibial Defects in Primary Total Knee Arthroplasty

Hosaka¹,

Saito²,

Oyama³

et al. 2017

Orthopedics

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Autologous bone grafting is an established method to overcome bone deficiencies in primary total knee arthroplasty (TKA). However, recently, metal augments have been used by many surgeons. Although autologous bone grafting is a common technique, few large studies have described its success in achieving bone union in primary TKA. The goal of this study was to evaluate primary TKA with autologous bone grafting for tibial defects. A total of 68 knees that had undergone arthroplasty with autologous bone grafting with more than 1 year of follow-up were evaluated. Average follow-up was 6.6 years (range, 1.2-14.6 years). The autologous bone grafting procedure attached the proximal portion of the tibial resection from the lateral side to the bone graft on the medial side with 2 screws. The prosthesis, which had a standard and nonrevision stem, was implanted with cement. Bone union was assessed with fluoroscopic radiography with a weight-bearing anteroposterior view. The rate of bone union was 97% (65 knees). Correction of preoperative alignment was achieved and maintained until final follow-up. Postoperative knee angle and knee and function scores showed significant improvement. One infection occurred, but there were no local complications, such as backout of screws or collapse of bone grafts. The authors believe that autologous bone graft within TKA is a relatively simple and effective procedure that provides good bone union. [Orthopedics. 2017; 40(4):e604-e608.].

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Union, Knee Alignment, and Clinical Outcomes of Patients Treated With Autologous Bone Grafting for Medial Tibial Defects in Primary Total Knee Arthroplasty

Hosaka¹,

Saito²,

Oyama³

et al. 2017

Orthopedics

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“…The failure rate of bone grafting at 6.8 years after TKRA was reported as 3% in the study by Watanabe et al17). Ahmed et al18) reported there was no case of failure during 10 years of follow-up period. We have used autogenous bone grafts obtained during tibial resection for contained defects and attempted to restore bone quality with the use of autogenous or allogenic bone grafts in young patients with non-contained defects.…”

Section: Discussionmentioning

confidence: 96%

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

Baek

Kim

Choi

2013

Knee Surg Relat Res

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PurposeTo analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect.Materials and MethodsWe analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system.ResultsThe mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters.ConclusionsPrimary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA.

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“…Cementation would have had the advantage of providing immediate stability [15,16], though would not have functioned as a biological scaffold, and might have caused thermal necrosis of the surrounding bone possibly leading to further osteolysis [17,18]. Autologous bone grafting was also considered because of its biological advantages, as well as its proven record in dealing with small tibial bony defects [19], and with impaction grafting in knee and hip revision arthroplasty [20]. …”

Section: Discussionmentioning

confidence: 99%

Granuloma debridement and the use of an injectable calcium phosphate bone cement in the treatment of osteolysis in an uncemented total knee replacement

Atkinson

Ranawat

Oakeshott

2010

Journal of Orthopaedic Surgery and Research

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Polyethylene particulate debris-induced periprosthetic osteolysis is a known complication of knee arthroplasty surgery, and may result in the need for revision surgery. The management of these bony defects can be surgically challenging, and full revisions of well-fixed total knee components can lead to substantial bone loss. We present the case of a 71 year old man who developed knee pain and osteolysis around an uncemented total knee replacement. Due to significant medical comorbidies he was treated by percutaneous cyst granuloma debridement and grafting using an injectable calcium phosphate bone substitute. There were no wound complications, and the patient was allowed to fully weight-bear post-operatively. Histopathology and microbiology of the cyst material confirmed polyethylene granulomata without any evidence of infection. At 6 weeks post-operatively the patient's previous knee pain had resolved, he was able to comfortably fully weight-bear. Preoperative scores (Knee Society Score (KSS) 41, WOMAC score 46.2, and Oxford Knee Score 39) had all improved at the 12-month post-operative review KSS 76, WOMAC 81.7 and Oxford Knee score 21). This is a safe and effective technique with minimal morbidity and may be an appropriate treatment modality when more extensive revision surgery is not possible. The case is discussed with reference to the literature.

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Autogenous Bone Grafting of Uncontained Bony Defects of Tibia During Total Knee Arthroplasty

Cited by 22 publications

References 22 publications

Union, Knee Alignment, and Clinical Outcomes of Patients Treated With Autologous Bone Grafting for Medial Tibial Defects in Primary Total Knee Arthroplasty

Union, Knee Alignment, and Clinical Outcomes of Patients Treated With Autologous Bone Grafting for Medial Tibial Defects in Primary Total Knee Arthroplasty

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

Granuloma debridement and the use of an injectable calcium phosphate bone cement in the treatment of osteolysis in an uncemented total knee replacement

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