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Purpose <p>Managing peripheral bone loss during primary total knee arthroplasty (TKA) represents a technical and economic challenge in resource-constrained facilities. This study evaluates mid- to long-term outcomes of local structural bone autografting secured with cortical screws, without supplementary extension stems.</p> Methods <p>We retrospectively reviewed 125 consecutive patients (92 females, 33 males; mean age 66.8 ± 6.2&#xa0;years) treated between 2012 and 2021 for AORI Type 1 (n = 27) or Type 2A (n = 98) peripheral defects at the proximal tibia (n = 96) or distal femur (n = 29). Autologous bone cuts were manually sculpted, wedged into the defect, and fixed with two 3.5-mm cortical screws. Full weight-bearing was restricted for six&#xa0;weeks. Knee Society Scores (KSS), range of motion, and radiographs were analyzed. Survivorship was calculated using the Kaplan–Meier method.</p> Results <p>At a mean follow-up of 7.4 ± 1.6&#xa0;years (minimum, 5.0&#xa0;years), mean objective KSS improved from 41.6 ± 5.8 preoperatively to 88.7 ± 5.1 at final evaluation (p &lt; 0.001); mean functional KSS increased from 39.1 ± 6.9 to 85.4 ± 5.3 (p &lt; 0.001). Complete radiographic graft integration occurred in 121 knees (96.8%) within 12&#xa0;months. Four patients (3.2%) showed stable, asymptomatic fibrous non-union. Mechanical complications requiring revision occurred in three cases (2.4%): two late aseptic loosenings and one early resorption. Overall Kaplan–Meier implant survivorship was 97.6%.</p> Conclusion <p>Stemless local bone autografting with cortical screw fixation provides predictable remodeling and durable mid-term survivorship. It represents a reliable, practical alternative for managing moderate peripheral defects during primary TKA, particularly in resource-constrained settings.</p>

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Mid-term outcomes of stemless local bone autografting for moderate defects in primary total knee arthroplasty: a series of one hundred and twenty five cases

  • 期刊论文

  • 发表日期：

    2026年7月14日

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  • Youssef Jalal,
  • Soukaina Zaimi,
  • Younss Chouikh,
  • Hicham Bousbaa,
  • Hassane Zejjari,
  • Taoufiq Cherrad

摘要

Purpose

Managing peripheral bone loss during primary total knee arthroplasty (TKA) represents a technical and economic challenge in resource-constrained facilities. This study evaluates mid- to long-term outcomes of local structural bone autografting secured with cortical screws, without supplementary extension stems.

Methods

We retrospectively reviewed 125 consecutive patients (92 females, 33 males; mean age 66.8 ± 6.2 years) treated between 2012 and 2021 for AORI Type 1 (n = 27) or Type 2A (n = 98) peripheral defects at the proximal tibia (n = 96) or distal femur (n = 29). Autologous bone cuts were manually sculpted, wedged into the defect, and fixed with two 3.5-mm cortical screws. Full weight-bearing was restricted for six weeks. Knee Society Scores (KSS), range of motion, and radiographs were analyzed. Survivorship was calculated using the Kaplan–Meier method.

Results

At a mean follow-up of 7.4 ± 1.6 years (minimum, 5.0 years), mean objective KSS improved from 41.6 ± 5.8 preoperatively to 88.7 ± 5.1 at final evaluation (p < 0.001); mean functional KSS increased from 39.1 ± 6.9 to 85.4 ± 5.3 (p < 0.001). Complete radiographic graft integration occurred in 121 knees (96.8%) within 12 months. Four patients (3.2%) showed stable, asymptomatic fibrous non-union. Mechanical complications requiring revision occurred in three cases (2.4%): two late aseptic loosenings and one early resorption. Overall Kaplan–Meier implant survivorship was 97.6%.

Conclusion

Stemless local bone autografting with cortical screw fixation provides predictable remodeling and durable mid-term survivorship. It represents a reliable, practical alternative for managing moderate peripheral defects during primary TKA, particularly in resource-constrained settings.