T2B Defect Both Plateaus Figure

The Type 2B defect (Fig. 9.8) involves both plateaus. Radiographs of T2B defects demonstrate damage to the metaphyseal segment of

Bone Lesions Tibia Below Knee

the tibia by either component subsidence, osteolysis, or both. The damage may extend to the level of the fibular head, but should not include extensive destruction of bone below this level. The meta-physeal flare of the tibia should be reduced but still present. Oste-olytic lesions should have a well-defined border with some cancellous bone present for cement interdigitation at the time of the reconstruction.

The surgical management of a T2B defect usually includes the use of a long-stemmed tibial component and reconstruction of the tibial plateaus by bone graft, augments, or an extra thick tibial component. A wedgeshaped component is appropriate for the T2B defect if the bone loss is significant in both plateaus, but greater in one plateau. A canal-filling stem is preferable, particularly if a structural bone graft has been used.

Occasionally, cement fill is used for T2B defect reconstructions. Reinforcement with cancellous screws may provide a stronger construct than cement alone. The most difficult but perhaps the most important aspect of Type 2 and Type 3 tibial reconstructions is achieving cement interdigitation with the graft. An advantage to using allograft bone is recreating a cancellous bone bed for cement interdigitation with host bone. union of an allograft to host bone is not a problem.7 In fact, the durability of major structural allo-grafts in revision knee surgery appears to be satisfactory.

Postoperative radiographs of T2B repairs reveal a tibial component augment, cement fill, or allograft to restore joint line level. The augment may be an extra thick tibial baseplate, a step wedge, or an angular wedge beneath the component. There may be a bone graft in addition to the augment. If the defect has not been repaired to restore joint line level, the tibial baseplate is at or below the level of the fibular head. In some instances, the tibial baseplate may be close to the fibular head, with extensive cement penetration below the level of the fibular head.

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