Abstract
Purpose
Most of revision TKA needs bone reconstruction. The success of revision TKA depends on how well the bone reconstruction can be done. The method of reconstruction includes bone cementing, metal augmentation, allogenic bone graft, APC and tumor prosthesis, etc.
In moderate to severe bone defect, allograft is needed. However, allogenic bone graft is surgically demanding and needs long operation time, which is very risky to the elderly patients. The authors revised an alternative method of bone defect reconstruction using cementing method with multiple screws augmentation.
Methods
There were 12 cases of patients with large defect which could not be reconstructed with metal augment from April 2012 to April 2014. The authors performed 3 to 5 screws fixation on the defect site. Sclerotic bone is prepared with burring for better cementing. 3 ∼ 5 screws according to the size of defect. The length of screw fixation was determined as deep to the bone until stable fixation just beneath the implant. When drilling for the screw insertion, intramedullary guide is put into the medullary canal so as not to interfere with implant insertion. The defect is filled with cement during prosthesis fixation. Weight bearing was permitted on postoperative 3rd day, as usual manner of primary TKA.
Results
According to the AORI classification, there were 10 cases of 2A and 2 cases of 2B. Mean follow up period was average 15 months. The number of screw insertion was 4.3 ea (2∼8). Average operation time was 1 hour and 57 minutes. Mean ROM was 107.9. HSS score, KSS score ad WOMAC score were 86.3, 92.8 and 11, respectively. There were no case of infection and loosening at the last follow-up.
Conclusion
Cementing with multiple screws augmentation technique is a good alternative of bone reconstruction.
