Primary total knee replacement in grade 4 osteoarthritis with bone defect of bilateral knee joint: Case report

Abstract

While tackling with bone deficiencies in the context of total knee arthroplasty, it is imperative for the arthroplasty surgeon to arm himself with an in-depth knowledge on the various management options available and to use the right option for the right type of defect in the right patient. this case report is on the various options available and discuss the evolving concepts and recent trends with regard to the implications and treatment of bone deficiencies, in primary total knee arthroplasty. Relevant literature is evaluated with specific focus on the modality used for managing a defect, their clinical and radiological outcomes and failure rates. Out of various classifications described, Anderson Orthopedic Research Institute (AORI) system is universally employed to classify the bone defects. The currently available management options include more tibial resection, the use of bone cement to fill the defect, with or without augmentation with screws, bone grafting which may be autograft or allograft, metal augments, metaphyseal cones and sleeves. There is no single option which can be applied universally; each has its own advantages, disadvantages and specific indications with regard to application in specific types of defects, in specific patients. In This specific case report, we have a patient 75yr old man with Grade 4 Osteoarthritis B/L knee joint with posteromedial bone defect, Underwent primary total knee arthroplasty with augmentation of bone defect with Autograft Taken from femoral cuts and intercondylar box cut graft, fixed with screws along with bone cement used for stabilization of tibial component with metaphyseal stem.