Short-term effectiveness of bone cement combined with screws for repairing tibial plateau defect in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Shaofeng , WANG Sen , WU Tianhao , FAN Zhongwei , ZHANG Yue , RAO Yong ,  TAN Meiyun

Department of Bone and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

TAN Meiyun, Email: drtmy@126.com

Keywords：

Total knee arthroplasty; tibial plateau; bone defect; bone cement; screw

DOI：

10.7507/1002-1892.201704016

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Objective To summarize the effectiveness of bone cement combined with screws for repairing tibial plateau defect in total knee arthroplasty (TKA). Methods Between March 2013 and March 2016, 30 patients were treated with TKA and bone cement combined with screws for repairing tibial plateau defect. Of the 30 patients, 8 were male and 22 were female, with an average age of 64.7 years (range, 55-71 years). And 17 cases were involved in left knees and 13 cases in right knees; 22 cases were osteoarthritis and 8 cases were rheumatoid arthritis. The disease duration ranged from 9 to 27 months (mean, 14 months). Knee Society Score (KSS) was 41.63±6.76. Hospital for Special Surgery Knee Score (HSS) was 38.10±7.00. The varus deformity of knee were involved in 19 cases and valgus deformity in 11 cases. According to the Rand classification criteria, tibial plateau defect were rated as type Ⅱb. Results All incisions healed by first intention, without infection or deep vein thrombosis. All the patients were followed up 27.5 months on average (range, 10-42 months). At last follow-up, HSS score was 90.70±4.18 and KSS score was 93.20±3.75, showing significant differences when compared with preoperative values (t=–58.014, P=0.000; t=–60.629, P=0.000). Conclusion It is a simple and safe method to repair tibial plateau defect complicated with varus and valgus deformities with bone cement and srews in TKA.

Citation： LIU Shaofeng, WANG Sen, WU Tianhao, FAN Zhongwei, ZHANG Yue, RAO Yong, TAN Meiyun. Short-term effectiveness of bone cement combined with screws for repairing tibial plateau defect in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1055-1058. doi: 10.7507/1002-1892.201704016 Copy

1.	Ritter MA, Keating EM, Faris PM. Screw and cement fixation of large defects in total knee arthroplasty. A sequel. J Arthroplasty, 1993, 8(1): 63-65.
2.	Ahmed I, Logan M, Alipour F, et al. Autogenous bone grafting of uncontained bony defects of tibia during total knee arthroplasty a 10-year follow up. J Arthroplasty, 2008, 23(5): 744-750.
3.	Ritter MA, Harty LD. Medial screws and cement: a possible mechanical augmentation in total knee arthroplasty. J Arthroplasty, 2004, 19(5): 587-589.
4.	Kharbanda Y, Sharma M. Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees. Indian J Orthop, 2014, 48(3): 313-318.
5.	Chung KS, Lee JK, Lee HJ, et al. Double metal tibial blocks augmentation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 214-220.
6.	Qiu YY, Yan CH, Chiu KY, et al. Review article: Treatments for bone loss in revision total knee arthroplasty. J Orthop Surg (Hong Kong), 2012, 20(1): 78-86.
7.	Sugita T, Aizawa T, Miyatake N, et al. Preliminary results of managing large medial tibial defects in primary total knee arthroplasty: autogenous morcellised bone graft. Int Orthop, 2016, 41(5): 931-937.
8.	Rand JA. Bone deficiency in total knee arthroplasty. Use of metal wedge augmentation. Clin Orthop Relat Res, 1991, (271): 63-71.
9.	Daines BK, Dennis DA. Management of bone defects in revision total knee arthroplasty. Instr Course Lect, 2013, 62: 341-348.
10.	Sugita T, Aizawa T, Sasaki A, et al. Autologous morselised bone grafting for medial tibial defects in total knee arthroplasty. J Orthop Surg (Hong Kong), 2015, 23(2): 185-189.
11.	杨光, 杨晓迪, 王刚, 等. 同种异体骨移植钢缆固定修复膝关节置换胫骨平台缺损 1 例. 中国骨伤, 2015, 28(12): 1099-1101.
12.	Villanueva-Martínez M, De la Torre-Escudero B, Rojo-Manaute JM, et al. Tantalum cones in revision total knee arthroplasty. A promising short-term result with 29 cones in 21 patients. J Arthroplasty, 2013, 28(6): 988-993.
13.	Brand MG, Daley RJ, Ewald FC, et al. Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency. Clin Orthop Relat Res, 1989, (248): 71-79.
14.	Fehring TK, Peindl RD, Humble RS, et al. Modular tibial augmentations in total knee arthroplasty. Clin Orthop Relat Res, 1996, (327): 207-217.
15.	Chen F, Krackow KA. Management of tibial defects in total knee arthroplasty. A biomechanical study. Clin Orthop Relat Res, 1994, (305): 249-257.
16.	Frehill B, Crocombe AD, Agarwal Y, et al. Finite element assessment of block-augmented total knee arthroplasty. Comput Methods Biomech Biomed Engin, 2015, 18(15): 1726-1736.
17.	Lotke PA, Wong RY, Ecker ML. The use of methylmethacrylate in primary total knee replacements with large tibial defects. Clin Orthop Relat Res, 1991, (270): 288-294.
18.	Berend ME, Ritter MA, Keating EM, et al. Use of screws and cement in primary TKA with up to 20 years follow-up. J Arthroplasty, 2014, 29(6): 1207-1210.
19.	Berend ME, Davis PJ, Ritter MA, et al. "Thicker" polyethylene bearings are associated with higher failure rates in primary total knee arthroplasty. J Arthroplasty, 2010, 25(6 Suppl): 17-20.
20.	裴征, 关振鹏, 张绍龙, 等. 重度膝内翻伴骨缺损的全膝表面置换术中的自体骨移植治疗. 北京大学学报(医学版), 2011, 43(5): 707-713.
21.	Sculco PK, Abdel MP, Hanssen AD, et al. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J, 2016, 98-B(1 Suppl A): 120-124.
22.	Juvonen T, Nuutinen JP, Koistinen AP, et al. Biomechanical evaluation of bone screw fixation with a novel bone cement. Biomed Eng Online, 2015, 14: 74.
23.	Lombardi AV, Berend KR, Adams JB. Management of bone loss in revision TKA: it’s a changing world. Orthopedics, 2010, 33(9): 662.

1. Ritter MA, Keating EM, Faris PM. Screw and cement fixation of large defects in total knee arthroplasty. A sequel. J Arthroplasty, 1993, 8(1): 63-65.
2. Ahmed I, Logan M, Alipour F, et al. Autogenous bone grafting of uncontained bony defects of tibia during total knee arthroplasty a 10-year follow up. J Arthroplasty, 2008, 23(5): 744-750.
3. Ritter MA, Harty LD. Medial screws and cement: a possible mechanical augmentation in total knee arthroplasty. J Arthroplasty, 2004, 19(5): 587-589.
4. Kharbanda Y, Sharma M. Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees. Indian J Orthop, 2014, 48(3): 313-318.
5. Chung KS, Lee JK, Lee HJ, et al. Double metal tibial blocks augmentation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 214-220.
6. Qiu YY, Yan CH, Chiu KY, et al. Review article: Treatments for bone loss in revision total knee arthroplasty. J Orthop Surg (Hong Kong), 2012, 20(1): 78-86.
7. Sugita T, Aizawa T, Miyatake N, et al. Preliminary results of managing large medial tibial defects in primary total knee arthroplasty: autogenous morcellised bone graft. Int Orthop, 2016, 41(5): 931-937.
8. Rand JA. Bone deficiency in total knee arthroplasty. Use of metal wedge augmentation. Clin Orthop Relat Res, 1991, (271): 63-71.
9. Daines BK, Dennis DA. Management of bone defects in revision total knee arthroplasty. Instr Course Lect, 2013, 62: 341-348.
10. Sugita T, Aizawa T, Sasaki A, et al. Autologous morselised bone grafting for medial tibial defects in total knee arthroplasty. J Orthop Surg (Hong Kong), 2015, 23(2): 185-189.
11. 杨光, 杨晓迪, 王刚, 等. 同种异体骨移植钢缆固定修复膝关节置换胫骨平台缺损 1 例. 中国骨伤, 2015, 28(12): 1099-1101.
12. Villanueva-Martínez M, De la Torre-Escudero B, Rojo-Manaute JM, et al. Tantalum cones in revision total knee arthroplasty. A promising short-term result with 29 cones in 21 patients. J Arthroplasty, 2013, 28(6): 988-993.
13. Brand MG, Daley RJ, Ewald FC, et al. Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency. Clin Orthop Relat Res, 1989, (248): 71-79.
14. Fehring TK, Peindl RD, Humble RS, et al. Modular tibial augmentations in total knee arthroplasty. Clin Orthop Relat Res, 1996, (327): 207-217.
15. Chen F, Krackow KA. Management of tibial defects in total knee arthroplasty. A biomechanical study. Clin Orthop Relat Res, 1994, (305): 249-257.
16. Frehill B, Crocombe AD, Agarwal Y, et al. Finite element assessment of block-augmented total knee arthroplasty. Comput Methods Biomech Biomed Engin, 2015, 18(15): 1726-1736.
17. Lotke PA, Wong RY, Ecker ML. The use of methylmethacrylate in primary total knee replacements with large tibial defects. Clin Orthop Relat Res, 1991, (270): 288-294.
18. Berend ME, Ritter MA, Keating EM, et al. Use of screws and cement in primary TKA with up to 20 years follow-up. J Arthroplasty, 2014, 29(6): 1207-1210.
19. Berend ME, Davis PJ, Ritter MA, et al. "Thicker" polyethylene bearings are associated with higher failure rates in primary total knee arthroplasty. J Arthroplasty, 2010, 25(6 Suppl): 17-20.
20. 裴征, 关振鹏, 张绍龙, 等. 重度膝内翻伴骨缺损的全膝表面置换术中的自体骨移植治疗. 北京大学学报(医学版), 2011, 43(5): 707-713.
21. Sculco PK, Abdel MP, Hanssen AD, et al. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J, 2016, 98-B(1 Suppl A): 120-124.
22. Juvonen T, Nuutinen JP, Koistinen AP, et al. Biomechanical evaluation of bone screw fixation with a novel bone cement. Biomed Eng Online, 2015, 14: 74.
23. Lombardi AV, Berend KR, Adams JB. Management of bone loss in revision TKA: it’s a changing world. Orthopedics, 2010, 33(9): 662.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of bone cement combined with screws for repairing tibial plateau defect in total knee arthroplasty

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