Metalic Augments: The Best Method for Reconstruction of Bone Defects in Primary Knee Arthroplasty

摘要

Proximal tibial bony deficiencies are frequent conditions in primary and revision total knee arthroplasty. Modular tibial metal augmentations were introduced to address these deficiencies hoping that they are better than other methods of reconstruction (cement reinforced with screws or structural bone graft). Material and Methods. During Jan 2000-Jul 2009, 407 total knee arthroplasty were performed in our department. 24 patients had a varus alignament of the knee more than 25°. For replacement we have used the same postero-stabilised prosthesis. The surgical exposure was standard in all cases. We have used for ligament balancing the basic principles. For bony reconstruction we have used a metal medial wedge protected with a stem with or without offset in 9 cases. The stem lenght was 80 mm or 155 mm, according to bone quality and in all cases was uncemented. press fit. In all cases we have used a metal wedge of 10mm for reconstruction the bone defect after we have done the standard tibial cut. The follow-up of all patients is one year. All cases were followed radio graphically and clinically with KSS score Results. Postoperatively, the functional score improved from 33 to 88 points. The results were excellent in 80% of the cases and good in 20% of the cases. There were no complications and / or reoperations. The postoperative range of motion was 95° (85°-110°). The height of joint line was restored and it was no case of patella baja. Conclusions. The technique of modular tibial metal augmentations should be considered as an effective solution in severe proximal tibial bony deficiencies. The technique is easy and fast, it allows a fast recovery of the patient with immediate weight bearing. The wedge allows to do a proper tibial cut and it helps in restoring the normal joint line.