Primary knee arthroplasty in severe arthrisic genu varo with tibial bone defect.

Abstract

Abstract

The purpose of this article is to describe the management of an infrequent case of severe osteoarthritic genu varus with an important tibial bone defect.

Introduction: Genu varum deformity is the most common type of gonarthrosis, in advanced stages it leads to significant bone loss, becoming one of the most challenging aspects in the management of knee arthroplasty.

Clinical case: 68-year-old male, with dysbasia of the right lower limb, gait with support, at the level of the right knee there is evidence of non-reducible arthritic genu varus (Ahlbäck V), with complete ranges of flexo-extension.

Surgical technique: We performed a total joint replacement of the right knee with a revision tibial stem plus a 12x24mm metal wedge for a bone defect. During the surgical act, the stability of the implants, patellar tracking and full ranges of movement were checked.

Results: satisfactory post-surgical radiological assessment of the patient, he progresses favorably, knee mobility, standing and walking are stimulated early.

Discussion: Femoral and tibial resection should be less than 8 mm if there is severe deformity or tibial subluxation indicating recurvatum instability. With bone gaps greater than 10mm, the tibia should not be cut to the level of the gap, the strength of the bone support is reduced, and the use of a narrower tibial component reduces the bearing area.

Conclusions: In our case, it is advisable to use augmented prostheses with a reinforced metal wedge because they are mechanically superior to cement or grafts in terms of osseointegration and implant stability.