The Treatment And Effect Of Tibial Defects Of OA With Varus In Total Knee Arthroplasty

PurposeTo investigate the treatment and effect of tibial defects of OA withvarus in total knee arthroplasty.Materials and MethodsClinical information: From december2012to december2014,39cases(53knees) underwent the total hip arthroplasty in department oforthopedic of China-Japan Union Hospital of JiLin university, including13males (17knees) and26females (36knees). The age was53to79yeas old, aver age68.25years old. The separate criteria of all tibialdefects is Rand: type a34knees, type b19knees. A group receivedcement for osseous defects. B group received screws and cement. Cgroup received cement and bone grafts. According to postoperativeimaging, complications, ROM, and KSS scores, the curative effect isevaluated.MethodsThe preoperative evaluation includes function and the extent ofmalformation, osseous defects and bone condition by X-ray or BMD, andKSS scores. The intra-operative treatment of defects: Type a(34knees) received cement,11knees of type b received screws and cement,8kneesof type b received bone grafts and cement. All of54knees receivedprimary TKA. According to X-ray after every follow-up, complicationsincluding prosthesis, cement, osteolysis and bone resorption. ROM wasevaluated by physical examination. Using KSS scores in the preoperativeand postoperative follow-up, with the help of SPSS17.0evaluate theeffect of the TKA.Results39cases (53knees) were followed up for6-48months, with anaverage of22.6months. No bone grafts failed to heal and no boneresorption was found. Only1case with cement fracture,1case with DVT,1case with infection, and2cases with translucid bands which were notdeveloped gradually were found. KSS scores of group A were promotedfrom preoperatively (45.15±5.84) to (94.25±5.02) points in lastfollow-up, good rate of96.5%. KSS scores of group B were promotedfrom preoperatively (26.34±6.27) to (92.02±4.45) points in lastfollow-up, good rate of94.6%. KSS scores of group C were promotedfrom preoperatively (29.27±5.42) to (90.96±3.79) points in lastfollow-up, good rate of93.7%. All of the three group have significantlydifference (P<0.05). The three ways of using of cement (group A),screws and cement (group B), bone grafts and cement (group C) whichtreat tibial defects of varus result in good outcome and less complications in primary total knee arthroplasty.Conclusion1. Rand criteria can help develop a scientific and rational surgeryprogram.2. Using of cement, screws and cement, bone grafts and cementtreating tibial defects of OA with varus result in good outcome.①Patients whose body condition are worse receive cement.②Patients whose bone condition are worse receive screws andcement.③Patients whose bone condition are better receive bone graftsand cement.3. Bone condition evaluated by Preoperative X-ray and BMD areimportant to choosing surgery program.