Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Nowadays, patients with osteoarthritis in Thailand are likely to increase in number every year. There are approximately 462,000 people and most are females than males. The treatment is surgery knee replacement implants which must be imported from abroad and cost is expensive.Total knee prosthesis used in Thailand would not fit with the body of the Thai women because of the design total knee prosthesis use anatomical data of Europe and designed for both male and female, which is different in the knee structure. This research aims to study the size and shape of knee for Thai women and design total knee replacement. The using of finite elements is to assist in the analysis which focuses on the influence of the force active on and the effects of stress distribution on the part of the knee at different stages of gait cycle. The results of the study can measure the average size of Thai knee women base on analytical data. Anthropometric data on the proximal tibia and distal femur of 55 female knees were obtained using three dimensional computer tomographic measurements. The parametric studies are dimension analysis of the femoral mediolateral (fML) and femoral anteroposterior (fAP) dimension on distal femur surface and tibial mediolateral (tML), tibial anteroposterior (tAP) on proximal tibia surface. The measuring average values are 65, 60, 67 and 45 mm respectively. All parameters were compared to the size of the total knee prosthesis which currently used in Thailand. It is found that values are 70, 62, 68 and 48 mm respectively which is larger than the average Thai woman.The study of finite elements can be made aware of the stress distribution and stress in the area of artificial knee while walking and leading to the design of artificial knee joint to have size and shape suitable for Thai women.

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Alternative Management Of Bone Defect In Primary Total Knee Replacement

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00101 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0010

Author(s):

M.A Abdullah ◽

N Selvanathan ◽

S Kassim ◽

A.F Kassim ◽

S Chopra

Keyword(s):

Bone Loss ◽

Total Knee Replacement ◽

Bone Defect ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Proximal Tibia ◽

Treatment Options ◽

Bone Defects ◽

Total Knee ◽

Primary Total Knee

Introduction: Bone defects are not common in primary total knee arthroplasty (TKA) contrary to a revision setting. The surgeon must assess the degree of complexity preoperatively and intraoperatively and have a broad armamentarium available during surgery. Multiple surgical options are available to repair or reconstruct the loss of bone, these include: bone cement, bone grafts, metal augments and custom-made implants. Principles to consider in bone loss management are knee and patient-related. Bone defects in primary TKA are usually associated malalignment of the limb combined with severe destruction of the articular cartilage. The treatment options for bone defects in primary TKA should be focus on preserving of the host bone, joint line restoration, balancing the flexion /extension stability and stabilizing the prosthesis. Materials/Methods: We are presenting a 65 years old lady with severe osteoarthritis bilateral varus deformity with severe bone loss over the posterior tibia condyle. Pre operatively multiple radiographs AP, lateral, patella skyline and oblique view are taken. For this patien we taken CT scan for assessment of the bone defect particularly on the tabia side. The pre operative templating of the radiographs is fundamental important in this patient in planning for primary complex TKA . This patient underwent bilateral total knee replacement with semiconstraint implant with mesh and impaction bone grafting over the posterior apesct of proximal tibia. Result: This patient was susseccfully operated with no immediate and post operative complication. Patient which unable to walk because of severe deformity able to gain confidence level to walk and back to her daily living activity Discussion: Primary and revision TKA will continue to increase, proper management of femoral and tibia bone loss represents a common situation that have to be faced by the orthopaedic surgeon. Whatever technique is used in management of bone loss during knee arthroplasty, certain fundamentals must be applied and the remaining bone structure will guide treatment. For this case the bone defect was severe uncontained less than 50% of the posterior proximal was lost. Impaction grafting with mesh was performed to create back the proximal tibia. It’s give a new solid platform for the tibia tray to be inserted and this may allow the patient to weight bear immediately post operatively. This will avoid from using fully constrain implant which put more stress on the joint. Periarticular defect requiring more than a minimal prosthetic augment, it is imperative to use stemmed components to transfer stress away from join. Reestablishment of well-aligned and stable implants is necessary, but this can’t be accomplished without a sufficient restoration of an eventual bone loss Conclusion: There are several treatment options to deal with a specific bone defect in the primary TKA and these options will be dictated by the patient’s factors, the defect factors and surgeon experience. Careful preoperative planning is essential to ensure successful reconstruction with all the appropriate armamentarium prepared. References: Pagano MW, Trousdale RT Tibial Wedge augmentation for Bone deficiency in TKA. Clin Orthop Relats Res. 1995;321:151-5

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Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,841 patients

Acta Orthopaedica ◽

10.2340/17453674.2021.1006 ◽

2022 ◽

pp. 179-184

Author(s):

Valtteri S Tapper ◽

Konsta J Pamilo ◽

Jaason J Haapakoski ◽

Alar Toom ◽

Juha Paloneva

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Proximal Tibia ◽

Treated Group ◽

Tibia Fracture ◽

Proximal Tibia Fracture ◽

Female Sex ◽

Total Knee ◽

High Age

Background and purpose — Post-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF. Patients and methods — We identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded. Results — 7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up. Interpretation — Patients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality.

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