The Evaluation Of The Therapeutigal Effect Of Mixed Bone Autograft On Type C Proximal Tibial Defect In Primary TKA

Objective To evaluate the therapeutical effect of mixed bone autograft on Rand type C proximal tibial defect in primary total knee arthroplasty (TKA).Methods We retrospectively analyzed the data of patients from Feb.2002to Jun.2007,12cases (male/female:3/9) totally16knees with Rand type C proximal tibial bone defect were handled with granular bone autograft combining with structural bone autograft by the same surgeon. The age of subjects ranged from50to79(average63.4).11cases (14knees) suffered from osteoarthritis, and1case (2knees) suffered from rheumatoid arthritis. Bone defect was first shaped into ladder shape, then drilled in the lower wall of bone defect. Bone transplantation was performed pressing the cancellous bone4～6mm in diameter rongeured from the autograft, and immobilized with nails.The content folio wed-up including many aspect, such as:(1) Function evaluated by HSS scores by telephone or on-site investigation;②Take X—rays of knees after3d,1year and every year follow-up of double knees, observe bone cement layer bright line change and complications including osteolysis, bone resorption, infection and prosthesis.Results12patients (16knees), was followed-up for average of26.8months(12～48months).HSS score was promoted from preoperatively22.5(19to31) to87(78to96) points in latest follow-up, which has significantly difference (P <0.05),with4cases (6knees) falling into excellent (≥90points),7cases (9 knees) filling into good (80-89),1case(1knees) was moderate (70-79).The excellent and good proportion could reach93.75%.According to the X-ray follow-up, no case was found failed to heal, and no grafts mobilization, bone absorption, bone dissolution and tibial plateau collapse was detected. Although2knees were detected out with translucid bands, loosening and infection both were negative.Conclusion Autologous combined bone grafting is an effective procedure for treating proximal tibial bone defect, which could provide primary stability and result in good outcome. But the final therapeutic effect couldn’t be determined because of the lack long term and large amount of follow up study.