Use of autogenous onlay bone graft for uncontained tibial bone defects in primary total knee arthroplasty

BACKGROUND: The use of autogenous bone graft is a well–known technique for reconstruction of tibial bone defects in primary total knee arthroplasty (TKA). In cases where the size of the bone graft is inappropriate, the stability of bone graft fixation and subsequent bone graft to host bone incorporation may be compromised. We describe a simple and reliable technique of reconstruction in a proximal tibia bone defect at the time of primary TKA by using autogenous onlay bone graft (AOBG). METHODS: Records were reviewed of 19 patients (mean age, 72 years) who underwent primary TKA using AOBG without the additional allogenous bone or metal augments, between August 2013 and August 2014. RESULTS: Mean Knee Society score (KSS) in the 22 knees was significantly higher postoperatively than preoperatively (92 ± 4 vs. 30 ± 7, P < 0.001). The mean range of motion (ROM) in the 22 knees, which was 106 ± 12° preoperatively, improved to 112 ± 10° at last follow-up, but this this difference was not significant (P = 0.32). No migration of implants and presence of radiolucent lines at the bone cement-prosthesis interface were observed. Furthermore, the serial radiographs of 19 patients had a mean time of 3.2 months (range, 2.7–4.4 months) for solid union with cross trabeculation between the proximal tibial bone and graft. CONCLUSIONS: This simple AOBG supplement technique may biologically promote graft to host bone healing by enhancing fixation stability without the additional fixatives and assist the surgeon in managing the varying nature of uncontained bone defects. TRIAL REGISTRATION: Trial registration number: KCT0002328, May 15, 2017.