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Comparative Study
. 2007 Dec;31(6):823-9.
doi: 10.1007/s00264-006-0256-y. Epub 2007 Mar 29.

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

M Colangeli  1 , D Donati, M G Benedetti, F Catani, E Gozzi, E Montanari, S Giannini
Affiliations
Comparative Study

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

M Colangeli et al. Int Orthop. 2007 Dec.

Abstract
in English, French

Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement in bone tumours of the proximal tibia. The aim of this study was to compare two groups of patients with total knee modular megaprosthesis and osteochondral allograft through an objective analysis. Eighteen patients, ten treated with prosthesis (TKR group) and eight with osteochondral allografts (AL group), were included in the study. X-ray, muscular strength measurements, and studies of gait analysis including electromyography (EMG) were used to compare functional results of patients. In the TKR group a higher incidence of knee extension lag was found. While the TKR group had a prevalent knee stiff/hyperextension pattern with reduced rectus femoris activity, the AL group had a higher percentage of normal knee pattern. Knee extensor muscular strength was reduced in the TKR group. TKR functional performance during gait is in most cases abnormal, consistent with the weakness of the extensor apparatus and knee extension lag. Although a greater rate of normal walking was found in the AL group, problems related to a short patellar tendon, knee instability, and joint mismatching were considered to be responsible for abnormal knee kinematics. An allograft, when optimal reconstruction is performed, gives better functional results.

Les prothèses totales massives et les allogreffes ostéochondrales sont utilisées pour préserver le mouvement articulaire dans les tumeurs du tibia proximal. Le but de cette étude était de comparer 2 groupes de patients ayant reçus ces traitements. 18 patients étaient inclus dans l’étude, 10 traités par prothèse (groupe TKR) et 8 par allogreffe ostéochondrale (groupe AL). Les radiographies, la mesure de la force musculaire, l’étude de la boiterie incluant l’EMG étaient utilisées pour comparer les résultats fonctionnels. Dans le groupe TKR une plus grande incidence de perte d’extension était notée. Tandis que le groupe TKR avait une réduction de l’activité du Rectus fémorus , le groupe AL avait un plus grand pourcentage de fonction normale. La force musculaire des extenseurs était réduite dans le groupe TKR. La performance fonctionnelle durant la marche des TKR étaient la plupart du temps anormal avec faiblesse de l’appareil extenseur et perte d’extension. Bien qu’un taux plus élevé de marche normale était trouvé dans le groupe AL, les problèmes dû à un tendon rotulien court, une instabilité articulaire et à une articulation mal adaptée étaient supposés responsable d’une cinématique anormale du genou. L’allogreffe, quand une reconstruction optimale était réalisée donnait un meolleur résultat fonctionnel.

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Figures

Fig. 1
Fig. 1
Knee flexion-extension pattern: a=atypical (1 AL), b=hyperextended (5 TKR, 1 AL), c=stiff (2 TKR, 2 AL), d=flexed (2 TKR), e=regular (1 TKR, 3 AL). The grey band represents the control group (mean and standard deviation)
Fig. 2
Fig. 2
Rectus femoris activation pattern: formula image Normal/prolonged (3 TKR, 4 AL), formula image reduced (5 TKR, 2 AL), formula image absent (2 TKR, 2 L), formula image control
See this image and copyright information in PMC

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