Primary total knee arthroplasty in patient with non-union of femoral metadiaphysis (clinical case)

Introduction: there are several biological and mechanical approaches for compensation of extensile bone defi cy during primary and revision total knee arthroplasty (TKA) including metal augments, cones, sleeves, structural allograft impaction bone auto/allografting and mega-prosthesis. If bone defect extends to metadiaphysial area of femur or tibia the number of surgical options becomes more limited.Materials and methods: here are discussed the technical issues and mid-term outcome of replacing the distal femoral metaepiphysis by structural allograft during primary TKA due to non-union after several unsuccessful attempts of internal and external fi tion in patient with end-staged osteoarthritis. At a follow-up examination after 36 month, the patients complaints, clinical and functional state of the knee joint were studied using the KSS and WOMAC questionnaires, and radiographs were also assessed.Result: three years later, the patient used a cane when walking, minor pain in the knee joint occurred after covering 5-10 blocks, the range of motion was 0°/0°/100°. Functional assesment of the joint on the KSS scale - 80 points (good), WOMAC -27 points (good). On control radiographs, the position of the endoprosthesis components is correct, stable, and fusion of the structural allograft with the femur has ocurred.Сonclusion: the use of a structural allograft of the distal metaepiphysis of the femur in case of extensive defects of the third type or the absence of a metaepiphysis makes it possible to compensate for the existing defi cy of bone mass and achieve stable fi tion of the components of the endoprosthesis.