人工膝関節再置換術における骨欠損の対処法

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  • 青木 秀之
    東邦大学医療センター大森病院 整形外科
  • 中村 卓司
    東邦大学医療センター大森病院 整形外科
  • 宍倉 亘
    東邦大学医療センター大森病院 整形外科
  • 土谷 一晃
    東邦大学医療センター大森病院 整形外科

書誌事項

タイトル別名
  • Management of Bone Defect on Revision Total Knee Arthroplasty
  • ジンコウ シツカンセツ サイチカンジュツ ニ オケル ホネ ケッソン ノ タイショホウ

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<p>Objective: The objective of this study was to investigate the management of bone defects on revision total knee arthroplasty.</p><p>Methods: A total of 41 knee joints in 37 patients who underwent revision arthroplasty at our hospital (36 knee joints in 32 females, 5 knee joints in 5 males) were examined in this study. The mean age at revision arthroplasty was 65.7 years old (range, 28-82 years old) and the mean period from initial surgery to revision surgery was 9.8 years, respectively. Bone defects were evaluated using the Anderson Orthopaedic Research Institute classification. The management for each bone defect was also investigated.</p><p>Results: Bone defects of typesⅠ, Ⅱa and Ⅱb were present in 15 (42.9%), 12 (34.3%), and eight (22.8%) knee joints, respectively, on the femoral side, and in 13 (36.1%), 17 (47.2%), and six (16.7%) knee joints, respectively, on the tibial side. There were no type Ⅲ defects. On the femoral side, type Ⅰ defects were treated only with cement and autogenous bone grafting. In addition to these treatments, metal augmentation was used for five knee joints with type Ⅱa defects (41.7%) and five knee joints with type Ⅱb defects (62.5%). Autogenous iliac bone grafting was used for four knee joints with type Ⅱb defects (50%). On the tibial side, cement, autogenous bone grafting and thicker polyethylene inserts were used for type Ⅰ defects. Cement and autogenous bone grafting were used for type Ⅱ defects, with metal augmentation used for two knee joints with type Ⅱa defects (11.8%) and two knee joints with type Ⅱb defects (33.3%). Autogenous iliac bone grafting was used for four knee joints with type Ⅱb defects (66.7%).</p><p>Conclusion: An evaluation of patients with bone defects treated at our department showed that the management of type Ⅰ bone defects can be by replacement cement and autogenous bone grafting, and that long stem and metal augmentation are not necessary since the implant is the primary prosthesis. However, use of a long stem should be considered when the initial fixity of the implant is not sufficient due to the bone properties. The management of type Ⅱ defects by use of cement, autogenous bone grafting, and metal augmentation should be used concomitantly, and an implant with a long stem should be selected. In the management of type Ⅲ bone defects, allogeneic bone grafting should be considered, in addition to use of an implant with a long stem that can reach the diaphyseal region, particularly for a special component.</p>

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