Proximal Tibial Bone Graft

What is a bone graft?

Bone grafts may be needed for various orthopaedic surgeries of the foot and ankle. Bone grafts provide bony support and/or fill in areas where bone is absent. Bone grafts are either autograft, taken from the patient, or allograft, taken from a bone donor. The best bone graft provides enough bone and healing with minimal problems for the patient.
 

PTBG2.jpgCortical window to get bone from the proximal tibia.

What is a proximal tibial bone graft?

Proximal tibial bone graft (PTBG) is a type of autograft. The proximal tibia is the upper portion of the leg or shin bone that is just below the knee joint. Getting bone graft from this body part is usually less painful than from other areas like the pelvis.
 

When is a PTBG done?

PTBG is done for the treatment of severe arthritis, fractures, tumors, bone cysts, and unhealed joint fusions or fractures.
 

When should I avoid a PTBG?

The main reason to not have a PTBG is if you have hardware in the upper leg. Such devices include knee replacements, plates, and screws and rods. Other reasons to avoid a PTBG include skin problems or infection at the upper leg. Also, some orthopaedic procedures require a specifically shaped graft that the proximal tibia cannot provide. This kind of graft may need to be taken from the pelvis.
  

General Details of Procedure

The graft is usually taken from the leg above the foot/ankle being operated on. An incision is made over  an area of the upper leg. The incision may be small or large depending on how much graft is needed for the patient’s foot/ankle.
 
Two types of bone can be taken from the proximal tibia. The first is a harder, outer shell of bone that can be removed as a strip. The second is the spongier bone within the proximal tibia. Tools such as drills, chisels and scoops are used for a PTBG. At times, the surgeon may leave a drain in the leg at the bone for a short time to prevent excessive blood collection. The skin incision is typically closed with sutures or skin staples.
 
PTBG1.jpg
Surgical setup for a proximal tibial bone graft. The portals are marked around the knee in blue ink, including the planned incision.

What happens after PTBG?

Recovery from a PTBG is related to healing of the wound. This usually takes a couple of weeks. You may bear weight on your leg from which the bone was taken if the foot/ankle surgeries done at the same time allow for it. Bending the knee is usually allowed immediately after a PTBG.
 

Potential Complications

Potential problems after a PTBG include infection, fracture of the proximal tibia and pain related to the procedure.
 

Frequently Asked Questions

 
If proximal tibial bone graft is taken from my knee, will this prevent me from being able to have other procedures done in this area, such as knee replacement?
No. Most surgeries to treat knee problems can be done safely in the future.
 
Does harvesting tibial bone grafting damage the knee joint?
No. The graft is taken just below the actual joint with great care taken to protect the knee at all times.
 
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