Objective: To evaluate clinical results and radiological changes of grafted bone in rheumatoid arthritic knees treated with primary total knee arthroplasty (TKA) with massive bone grafts to tibial defects. Methods: Seventeen knees of sixteen patients after primary TKA were evaluated. Average age at surgery was 58.7 years old (range 49 to 69 years old). The average follow-up period was 8.9 years (range 6 to 16 years). According to Dorr's classification, 11 knees had peripheral defects. The other 6 knees had central defects. In the peripheral defect knees, local bone grafting was performed in 6 knees, iliac bone grafting was performed in 3 knees, and allogenic bone grafting was performed in 3 knees. In all of the central defect knees, local bone grafting was performed. All implants were fixed using bone cement. Clinical evaluation was performed using the Japanese Orthopaedic Association RA knee score (JOA score). Radiologically, lower leg alignment, clear zone around the component, and component angles ƒÀ and ƒÂ according to the knee society TKA evaluation system were evaluated. Furthermore, union of grafted bone to tibia, collapse of grafted bone, and absorption of the grafted bone were evaluated. Results: The mean JOA score improved from 43.5•}7.5 to 81.2•}12.1. Knee extension improved from a mean of -15.5•}14.7•‹ to -1.5•}4.9•‹. Knee flexion improved from a mean of 91.1•}18.6•‹ to 117.5•}

Eight knees with severe valgus deformity were treated with total knee arthroplasty. All patients were women, and the mean age for the patients was 55 years. The group included six knees with rheumatoid arthritis and two knees with osteoarthritis. Pre-and postoperative axial alignment was measured on weight-bearing long-standing radiographs. Clinical data summarized using the 100-point scoring system developed by the Knee Society. The femoro-tibial angle (FTA) averaged 156.5•‹ (range, 139 160•‹) preoperatively and 174.5•‹ (range, 170•‹•`180•‹) postoperatively. The Knee Society mean knee score was 26 (range, 15•`40) preoperatively and 89 (range, 68'100) postoperatively. The Knee Society mean postoperative functional score was 43 (range, 10•`60) preoperatively and 53 (range, 10•`70) postoperatively. There were three complications in the group. These were two superficial wound problems and one patellar subluxation. All patients were satisfied with the operation. All knees were stable with a functional range of motion at the last follow-up.