IJSR - International Journal of Scientific Research

Dr Lt Col SK Rai; Dr Surg Cdr Rohit Varma; Dr Surg Cdr SS Wani

Volume : VI, Issue : III, March - 2017

To study the outcome of Autograft reconstructions for Medial Tibial bone defects in primary total knee replacement in 80 cases of severe varus knees.

Dr Lt Col Sk Rai, Dr Surg Cdr Rohit Varma, Dr Surg Cdr Ss Wani

Abstract :

Introduction In Primary total knee arthroplasty the defects are usually secondary to severe malalignment and are associated with destructive changes in articular cartilage, bone and surrounding soft tissues. Various classifications have been described for medial tibial defect. Anderson Orthopaedic research institute [1] classifies the defect into three types. Type 1– minor defect that does not compromise the stability. Type 2: Loss of cancellous bone requiring reconstruction, A– one condyle, B– both condyles. Type 3: Bone loss that compromises the major portion of the condyle. The treatment of the tibial defect in primary total knee arthroplasty depends on whether it is a contained or uncontained defect and the size of the defect. Based on the size of defect it is divided into small (5mm). It is essential to have good quality X–ray for proper preoperative planning as well as to classify the defect. The various methods to treat tibial defects are; translation of the component away from the defect, lower tibial resection, polymethylmethacrylate cement filling +/– screws, autograft, metallic wedge augments or using custom implants. Large posteromedial asymmetrical osseous defects are often seen in proximal tibia while performing a primary total knee arthroplasty (TKA) in severe varus knees. Majority of these are peripheral uncontained defects. Depending upon the size of the defect, these can be treated with cementoplasty, cement with screw augmentation or metal wedges that constitute an integral part of modern knee systems [2]. The use of autografts is a viable alternative for the treatment of massive bone loss [3]. To achieve axial implantation of the prosthesis and stable fixation of the components, we performed osseous reconstruction of the medial tibial condyle defect using autologous bone grafts obtained from the cut proximal tibia or posterior femoral condyle cut. Our aim was to obtain firm seating of the tibial tray on a rim of viable bone, along with rigid press fixation of the medullary stem. Our study describes the outcome of management of medial tibial defect treated by using autograft for reconstructing large medial tibial defects (>5mm) using Sculco’s technique. The minimum followed up period was 03 year.