抄録
Six rheumatoid and osteoarthritic knees with severe medial bone loss were replaced with Miller-Galante prosthesis, using an iliac bone graft.
In all cases, the bone defects occupied most of the medial tibial condyles, involved the medial and posterior cortices, and had a depth of 1 to 3 cm.
The proximal tibia was resected at the subarticular level to set the prosthesis. After step-cutting the bottom of the bone defect, iliac bone blocks were grafted on top of each other facing the cortical crest outwards, and were fixed by lateral stapling. Moreover, they were also fixed vertically with the setting screws for the tibial prosthetic base plate.
At follow-up, which ranged from 10 to 21 months, femorotibial angle was improved, on an average from preoperative 202° to 175°. The preoperative range of knee motion averaged -15° in extension and 75° in flexion, while the postoperative was -5° and 80° respectively. No sinking of the tibia! component and no absorption of grafted bone were observed on X-rays. The tibial components were sepported by grafted bone.
Our procedure which retains as much bone stock as possible may be useful in the replacement surgery for the severely damaged knee.
