[The results of primary total knee arthroplasty with bone stock restoration by autologous grafts from resected bony ends].
OBJECTIVE
The aim of the study is the comparison of results of primary total knee arthroplasty with large bone stock deficiencies treated with autologous bone grafts from resected joint ends (both solid and morselized) with the group of patients in whom knee arthroplasty was made without the need of bone grafting.


METHODS
342 primary total knee replacements implanted till the end of 2004 at Orthopaedic and Traumatology Department in Lublin were examined. Bone stock defects were treated in 37 knees (35 patients). The necessity of reconstruction resulted from destruction of knee joint surfaces in advanced degenerative osteoarthritic processes or rheumatic disease. Autologous solid bone grafting was used in 22 knees, morselized in 13, meanwhile 2 different required both types of grafts. The medial tibial condyle bone stock defects were the most frequent--26 knees. Control group consists of 39 knees in 33 patients treated in the same period without the need for bone grafting and prostheses were implanted directly on resected surfaces. Preoperative and postoperative knee function was established with Hospital for Special Surgery Score (HSS). The X-rays were analyzed with the special regard for: correctness of implants placing, presence of radiolucence zones both around implants and grafts, and bone grafts healing.


RESULTS
The analysis of subsequent X-rays showed bone grafts healing (both solid and morselized) in 21 knees. In 4 knees progressive bone grafts lysis was observed. The remaining knees showed the presence of grafts and lack of evidence of healing in surrounding host bone. No differences were observed in number of intra- and postoperative complications, radiographic knee replacements geometry and long-term clinical results in both groups of patients.


CONCLUSIONS
1) Results of total knee replacements with autologous bone grafting for bone stock reconstruction are comparable with the results of TKR without the need for bone grafting. 2) Natural harvesting of the graft material from resected joint ends and effectiveness of reconstruction increase the value of the method. 3) The durability of early good results need further examination.
Gaweda
Krzysztof
K
Katedra i Klinika Ortopedii i Traumatologii, Akademia Medyczna im. prof Feliksa Skubiszewskiego w Lublinie.
Tarczyńska
Marta
M
Gagała
Jacek
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016025:Bone Transplantation / Q000000981:diagnostic imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D013977:Tibia / Q000637:transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome