[Autogeneous bone graft in the treatment of total knee arthroplasty for severe genu varus with tibial plateau bone defect].
OBJECTIVE
To introduce the method and experience of autogeneous bone graft for tibial plateau reconstruction during the procedure of total knee  arthroplasty for severe varus knees with bone defect in the medial tibial plateau.


METHODS
From April 2007 to March 2011, 19 knees of 16 osteoarthritic  patients who had serious genu varus with bone defect in medial tibial plateau underwent primary total knee arthroplasty, their mean varus degree being 32° (25°to 45°), and average age 66±8 years (52 to 77 years). Their preoperative knee functions are as follows:  the average range of motion (ROM) was 62°(37° to 90°); average knee society scure(KSS) knee score was 18 points (-24 to 41 points); average function score was 13 points (-21 to 43 points). During  operation, the slope bone defect of the medial tibial plateau was dressed into step-shape horizontal bone defect by osteotomy, and then the defect was  restored with the resected tibial plateau autograft whose thickness and shape were matched in advance; and the high-intensity cortical part of the  autograft was placed on the rim, to sustain the tibial prosthesis; and a lateral pressure from the rim had to be maintained to the autograft until the cement  under tibial prosthesis solidified. The long-stem tibial prostheses were used in 3 patients ( 3 knees ). All knee prostheses were fixed using antibiotic bone  cements.


RESULTS
The average follow-up after TKR was 25 months (3 to 50 months), the average ROM was 112° (95° to 125°); average KSS score 86  points (71 to 93 points), and knee function score 88 points ( 74 to 96 points). The nonunion, shift, fracture of the autologous graft bone were not found; no tibial  prosthesis became loose, either; no knee was revised for delayed infection or recurrent varus due to autologous graft bone absorption.


CONCLUSIONS
In  TKA for severe varus osteoarthritic patients with bone defect in the tibial plateau, there are various ways to regain its stability, and reconstruction is adopted  by using step-shape allograft in this paper. This method can not only restore the integrity of the tibial plateau, providing good initial stability of the  prostheses, and exempting from internal fixations, but also offer more reliable compatibility than other methods, reducing postoperative infection rates, and  obtaining satisfied initial curative effect.
Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing 100044, China.
Zheng
Z
Pei
Zhen-peng
ZP
Guan
Shao-long
SL
Zhang
Yun-peng
YP
Li
Zhuo
Z
Zhang
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D056305:Genu Varum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013977:Tibia / Q000473:pathology* / Q000637:transplantation*; D014182:Transplantation, Autologous