抄録
Two hundred-and-sixty-seven knees (181 patients) received cementless Mark II/III total knee replacement in our hospital from 1983 to 1986. Bone graft was used on 38 knees 23 with rheumatoid arthritis, 7 with osteoarthrosis and one with osteonecrosis in 31 patients who had severe bone defect.
Twenty-two knees (19 patients) could be followed more than 6 months and 17 knees (15 patients) more than one year. X-ray findings showed complete union in almost all cases, atrophy or sclerosis of the grafted bone in a few cases, and crushing of the grafted bone in 3 cases. Clinical results, which include gait, range of motion, stability and pain, were satisfactory except in cases which had crushed grafted bone.
These three cases were reviewed. The first case was a patient with rheumatoid arthritis and had received a wedge-shaped bone graft for repair of a fractured medial tibial plateau after total knee replacement. The second case was a patient with rheumatoid arthritis in whom a wide plate-shaped bone graft had been used because of a large bone defect of the medial tibial plateau. The cause of the crushing was thought to be the varus positioning. The last case was a patient with rheumatoid arthritis, osteoporosis and severe flexion contracture. A wedge-shaped bone graft was applied for repair of a fractured anterior tibial plateau after total knee replacement.
In conclusion our results show that, it would be better to set a plate-shaped bone block on a horizontal flat bed, and for a bone graft to be compact enough to avoid crushing due to osteoporosis and flexion contracture, especially in the case of using a wide graft.
