Abstract：Objective To explore the surgical technique and short-term effect of AORI Ⅱa type tibial defects of osteoarthritis with varus knee in primary total knee arthroplasty.Methods Eight patients (10 knees) suffered from severe genu varum and osteoarthritis and AORI Ⅱa type tibial defects.There were 3 knees of male patients and 7 knees of female patients.The average age was(68.8±6.7) years (from 61 to 79 years).Posterior CruciateStabilizing Total Knee Prostheses were used for all patients.Varus deformity were corrected by removal of the osteophytes，outward shift of osteotomy，selected soft tissue release.Met al block and stem extension were used for all patients，autologous bone graft for 2 knees.The range of motion and X-ray were observed regularly and the results were evaluated according to Lysholmscores.Results Intraoperative soft tissue balance was good，and restricted met al block was not used.The patients were followed up for 14~50 months (average 26 months) after operation.The Lysholm score was (25.16±5.04) before operation，(85.4±10.3) at last follow-up.The ROM was (61.37±10.24) ° before operation，(86.1±11.4)° at last follow-up.At the last follow-up，there was no complication of tibial plateau collapse and prosthesis loosening.ROM and Lysholm scores were significantly better than those before surgery(P＜0.05).Conclusion The short-term effectiveness of total knee arthroplasty using removal of the osteophytes，outward shift of osteotomy，selected soft tissue release，met al block augmentation and stem extension for AORI Ⅱa type tibial defects and varus knee deformity is satisfactory.Satisfactory alignment，stability of the tibia prosthesis and function of knee can be achieved.
［1］Qiu YY，Yan CH，Chiu KY.Review article：Treatments for bone loss in revision total knee arthroplasty［J］.J Orthop Surg (Hong Kong)，2012，20(1)：78-86.
［2］李晓辉.膝关节翻修术中骨缺损的处理［J］.中华骨科杂志，2015，35(3)：284-291.
［3］Engh GA.Bone loss with revision total knee arthroplasty：defect classification and alternatives for reconstruction［J］.Instr Course Lect，1999(48)：167-175.
［4］Nadorf J，Gantz S，Kohl K.Tibial revision knee arthroplasty：influence of modular stems on implant fixation and bone flexibility in AORI Type T2a defects［J］.Int J Artif Organs，2016，39(10)：534-540.
［5］Morgan H，Battista V.Constraint in primary total knee arthroplasty［J］.J Am AcadOrthop Surg，2005，13(8)：515-524.
［6］Li S，Chen Y，Su W，et al.Systematic review of patellar resurfacing in total knee arthroplasty［J］.Int Orthop，2011，35(3)：305-316.
［7］Radcliff KE，Orozco FR，Quinones D，et al.Preoperative risk stratification reduces the incidence of perioperative complications after total knee arthroplasty［J］.J Arthroplasty，2012，27(8 Suppl)：77-80；e1-8.
［8］Lee BS，Lee SJ，Kim JM，et al.No impact of severe varus deformity on clinical outcome after posterior stabilized total knee arthroplasty［J］.Knee Surg Sports Traumatol Arthrosc，2011，19(6)：960-966.
［9］吴彦杰，张育民，王亚康，等.全膝关节置换术治疗合并外翻畸形的晚期膝骨关节炎的疗效评价［J］.实用骨科杂志，2017，23(12)：1078-1081.
［10］Rodriguez-Merchan.Instability following total knee arthroplasty［J］.HSS J，2011，7(3)：273-278.
［11］危小东，陈永岗，刘佳，等.全膝关节置换术中胫骨平台骨缺损的最新处理进展［J］.实用骨科杂志，2016，22(12)：1100-1103.
［12］Brand MG，Daley RJ，Ewald FC，et al.Tibialtrayaugmentation w ith modular met al w edges for tibial bone stock deficiency［J］.Clin Orthop Relat Res，1989(248)：71-79.
［13］Tsukada S，Wakui M，Matsueda M.Met al block augmentation for bone defects of the medial tibia during primary total knee arthroplasty［J］.J Orthop Surg Res，2013，20(8)：36.
［14］黄传旺，Salim Jeddo，张元凯，等.矩形金属垫块在伴有胫骨骨缺损全膝关节置换术中的应用［J］.山东大学学报(医学版)，2015，53(6)：90-93.
［15］Brooks PJ，Walker PS.Tibial component fixation in deficient tibial bone stock［J］.Clin Orthop Relat Res，1984(184)：302-308.
［16］Hamai S，Miyahara H，Esaki Y，et al.Midterm clinical results of primary total knee arthroplasty using met al block augmentation and stem extension in patients with rheumatoid arthritis［J］.BMC Musculoskelet Disord，2015，16(1)：225.
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