Abstract
Uncontained peripheral bone defect in posteromedial tibial plateau is not an infrequent problem even in primary total knee arthroplasty, especially in Korean patients some of those have large angular deformities preoperatively.
We reviewed the clinical and radiological results of primary total knee replacements of 33 osteoarthritic knees in 28 patients with the use of metal block augmentation for uncontained peripheral tibial bone defects more than 5 millimeters in depth and more than a quarter of medial tibial plateau in width. Those defects were encountered in 75 knees (9.6%) during 779 primary total knee arthroplasties performed by single surgeon between January 2002 and December 2004 at our institution. Modular metal block augmentation was reserved for 42 knees, while the other knees were managed with bone-grafting or cement-filling techniques. Clinical and radiological follow-up more than 12 months were available from 33(78.6%) of 42 knees.
At a mean of 32.2 months (range:12~75 months), 31 knees (93.9%) except two cases of failure were evaluated as good or excellent. The average pre-operative American Knee Society Knee and Function scores were 32.5 and 38.6 respectively, which increased to 82.9 and 79.8 respectively at the latest follow-up. There were no radiolucent lines (RLLs) beneath the metallic block or tibial tray, which were progressive or more than 2 millimeters on radiographs, in those knees. Revisions were required for one delayed infection and another aseptic loosening of tibial component.
Non-progressive RLLs less than 2 millimeters at the cement-bone interface beneath the metallic block were noted in 10 (32.3%) of 31 knees. The RLLs appeared in 5 (41.7%) of 12 knees with metallic block augmentation alone and 5 (26.3%) of 19 knees which had been treated with the use of additional intramedullary stem augmentation, although this difference was not statistically significant. Since these radiolucent lines were not progressive or symptomatic at all, their clinical meanings or long-term consequences are not determined yet. All knees managed with the additional intramedullary stem augmentation revealed to have radiopaque lines adjacent to the stem on follow-up radiographs. The sclerotic halo around the tip of stem could be interpreted as evidence of the stem’s function in load sharing and might reflect secure fixation of tibial tray to bony interface.
We concluded that the use of modular metal block augmentation devices for peripheral tibial defects measuring more than 5 millimeters could provide a simple, rapid and dependable technique that provides predictable results. The observation that all knees managed with additional intramedullary stem augmentation would have sclerotic halo adjacent to the stem on follow-up radiographs may reflect an intramedullary stem is an important adjunct to bone defect management.
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