Aim of study
The aim of the study is to compare the results of primary total knee arthroplasty with large bone defects treated with autologous bone grafts from resected bone cuts with a group of patients in whom knee arthroplasty was made without the need for bone grafting.
Patients and methods
In all, 256 knees of patients suffering from painful osteoarthritis and who were admitted to Mansoura University Hospital over a period between 2003 and 2007 were studied. Bone stock defects were treated in 79 knees by structural solid bone from resected bone cuts and were fixed by screws. The control group consists of 167 knees treated in the same period without the need for bone grafting and prostheses were implanted directly on the resected surfaces. All patients were assessed according to Knee Society Score (KSS) parameters. The radiographs were analyzed with special regard for: correctness of implant placement, presence of radiolucent zones both around implants and grafts, and bone grafts healing.
Results
Bone grafts were incorporated in 79 knees within an average of 5.6 months. There was no graft collapse or stress fractures, loosening, or nonunion. The minimum follow-up period was 10 years. The postoperative KSS of both groups (total knee replacement (TKR) with no grafting and TKR with grafting) improved markedly (<0.0001) from the preoperative values, while the postoperative KSS did not differ significantly (=0.51 and 0.66) between the two groups
Conclusion
The use of autologous bone grafting for bone stock reconstruction in primary TKA are comparable with the results of TKR without the need for bone grafting. Autogenic bone grafting for defects in TKR is justified as it is biological, naturally harvested, and is cost effective besides preserving bone stock for future revisions.