Description of a Surgical Technique for the Treatment of Bone Defects in Knee Arthroplasties: Modified Stonehenge

Abstract

Bone loss can be a problem in knee arthroplasties, whether primary or revision. There are several classifications to quantify bone loss, both in relation to the depth of the defect and the integrity of the bone ring, distinguishing contained or non-contained defects. There are various proposals for correcting the bone defect, according to its extent, depth and containment, including bone cement, cement with metal support, homologous or heterologous bone grafting, metal wedges, trabeculated metal cones and sleeves. It is worth highlighting the importance of the metal components of the prosthesis being supported on a regular and stable surface, to allow correct alignment of the knee and stability of its components, thus guaranteeing a long-lasting arthroplasty. The objective of this report is to describe of a personal surgical technique, modified from the description of Keblish's technique, named Stonehenge. The technique we describe (modified Stonehenge) allows the correction of both contained and non-contained bone defects using autologous grafting with bone fragments resulting from bone cuts, which can be used in both the femur and tibia, with a small increase in surgical time, and without the need for specific instruments or additional cuts to regularize the bone surfaces. Compared to the use of metal wedges, the technique we describe has the following advantages: reducing blood loss, maintaining bone stock, allowing early ambulation and reducing the final cost of the surgery. As limitations of the technique, should be considered that the amount of bone obtained from the cuts may not be sufficient to fill larger defects, making it most suitable for epiphyseal and some metaphyseal defects, and not for meta-diaphyseal or broad metaphyseal defects.