初回TKAでの脛骨側骨欠損例に対する対処法の検討

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  • Management of Proximal Tibial Bone Defects in Primary Total Knee Arthroplasty
  • ショカイ TKA デ ノ ケイコツガワコツ ケッソンレイ ニ タイスル タイショホウ ノ ケントウ

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Objectives: Tibial bone defects are frequently encountered during total knee arthroplasty. There are several methods for treating the defects, such as cement filling, bone grafts, metal wedges, and extended stem fixation, from which we choose the most appropriate one depending on the defect type. The purpose of this study was to retrospectively review our techniques for treating peripheral defects in the proximal tibia.<br>Methods: We reviewed 15 knees with large tibial bone defects in 14 patients who underwent total knee arthroplasty; we measured the depth and width of the defect on preoperative anteroposterior roentgenograms. The defect depth was classified as moderate (20-29 mm) or severe (over 30 mm).<br>Results: The depth of the defect was moderate in 11 knees, and severe in 4 knees. The average depth was 26.2 mm and the average width was 34.4% (25.9% for moderate defects, 57.7% for severe defects). In the moderate defect group, we used cement filling alone in 5 knees, increased bone resection in 3 knees, the metal wedge alone in 1 knee, the extended stem alone in 1 knee, and a combination of the metal wedge and the extended stem in 1 knee. For the severe group, we used the extended stem in all cases.<br>Conclusion: For moderate defects, we need to consider the depth and the width to decide whether to use the metal wedge alone or with the extended stem. For severe defects, it is required to perform a combination of the metal wedge and the extended stem.

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