Knee Joint Bone Defects: Reconstruction With Bone Transport and Arthrodesis

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Regenerative medicine

Background:

• Total knee arthroplasty (TKA) is increasingly common, leading to more infectious complications, revision surgeries, and bone loss.
• Knee joint bone defects (KJBD) present a significant challenge in orthopedic reconstruction.
• Established techniques for KJBD management include Ilizarov and bone transport over nail (BTON) with arthrodesis.

Purpose of the Study:

• To compare the efficacy and outcomes of the Ilizarov technique versus the bone transport over nail (BTON) technique for reconstructing KJBD.
• To evaluate key parameters such as time in frame, external fixation index, limb length discrepancy, and complication rates.

Main Methods:

• A retrospective cohort study involving 29 patients with extensive KJBD.
• Patients underwent reconstruction using either the Ilizarov or BTON bone transport techniques.
• Primary outcome measures included time in frame, external fixation index (EFI), limb length discrepancy, and complication rates (Caton classification).

Main Results:

• The BTON group showed significantly shorter mean time in frame (191 days) compared to the Ilizarov group (566 days).
• External fixation index (EFI) was substantially lower for BTON (24.7 d/cm) versus Ilizarov (75.1 d/cm).
• Rates of union, limb length discrepancy, and complications were comparable between the two techniques.

Conclusions:

• Bone transport over nail (BTON) is the preferred technique for managing KJBD following failed total knee arthroplasty due to reduced treatment time and improved mechanical alignment.
• The Ilizarov method remains a viable option when BTON is contraindicated.
• Both techniques demonstrate comparable rates for union, limb length discrepancy, and complications.