Engh, J Bone Joint Surg Am 2007 - Use of Structural Allograft in Revision Total Knee Arthroplasty in Knees with Severe Tibial Bone Loss

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Use of Structural Allograft in Revision Total Knee Arthroplasty in Knees with Severe Tibial Bone Loss

Engh, Ammeen·J Bone Joint Surg Am·2007·162 citations·Case series

Background

Tibial bone loss is frequently encountered at the time of revision total knee arthroplasty, and the outcome of the revision often depends on the management of this bone deficiency. We examined the clinical and radiographic outcomes of a series of revision total knee arthroplasties in which a structural allograft had been used to reconstruct a tibial bone defect encountered at the time of the revision procedure.

Methods

From January 1985 through September 1999, one surgeon performed revision arthroplasty in 49 knees (47 patients) with a severe tibial bone defect.
The reasons for the revisions included polyethylene wear and osteolysis in 24 knees, aseptic loosening in 17 knees, infection in 5 knees, and failure for another reason for 3 knees.
Structural allograft was used alone in 35 knees and in conjunction with a tibial augment in 14 knees.
The mean age of the patients at the time of the revision arthroplasty with the allograft was 67 years.
The patients were assessed clinically with use of the Knee Society score and radiographically.

Results

The status of the implant was known for 46 of the 49 knees in this study.
It was unknown for one patient (one knee) who was lost to follow-up and for 2 patients (2 knees) who died less than 5 years postoperatively.
4 revision procedures in 4 patients failed and required a reoperation.
2 of the failures were due to infection.
At a mean of 97 months postoperatively, the mean Knee Society clinical score was 84 points for the knees that had not had a reoperation due to failure.
The mean arc of motion improved from 87 degrees preoperatively to 103 degrees at the most recent follow-up evaluation.
Histological evaluation of specimens retrieved at 2 autopsies demonstrated graft union to host bone.

Conclusions

A structural allograft provides a stable and durable reconstruction of a tibial bone deficiency. At a mean of 95 months postoperatively, we found no instance of graft collapse or aseptic loosening associated with the structural allograft. We recommend the use of a structural allograft for the management of severe tibial bone deficiency at the time of revision total knee arthroplasty.

Copyright remains with the authors and publisher.

Use of Structural Allograft in Revision Total Knee Arthroplasty in Knees with Severe Tibial Bone Loss

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Use of Structural Allograft in Revision Total Knee Arthroplasty in Knees with Severe Tibial Bone Loss

Engh, Ammeen·J Bone Joint Surg Am·2007·162 citations·Case series

Background

Tibial bone loss is frequently encountered at the time of revision total knee arthroplasty, and the outcome of the revision often depends on the management of this bone deficiency. We examined the clinical and radiographic outcomes of a series of revision total knee arthroplasties in which a structural allograft had been used to reconstruct a tibial bone defect encountered at the time of the revision procedure.

Methods

From January 1985 through September 1999, one surgeon performed revision arthroplasty in 49 knees (47 patients) with a severe tibial bone defect.
The reasons for the revisions included polyethylene wear and osteolysis in 24 knees, aseptic loosening in 17 knees, infection in 5 knees, and failure for another reason for 3 knees.
Structural allograft was used alone in 35 knees and in conjunction with a tibial augment in 14 knees.
The mean age of the patients at the time of the revision arthroplasty with the allograft was 67 years.
The patients were assessed clinically with use of the Knee Society score and radiographically.

Results

The status of the implant was known for 46 of the 49 knees in this study.
It was unknown for one patient (one knee) who was lost to follow-up and for 2 patients (2 knees) who died less than 5 years postoperatively.
4 revision procedures in 4 patients failed and required a reoperation.
2 of the failures were due to infection.
At a mean of 97 months postoperatively, the mean Knee Society clinical score was 84 points for the knees that had not had a reoperation due to failure.
The mean arc of motion improved from 87 degrees preoperatively to 103 degrees at the most recent follow-up evaluation.
Histological evaluation of specimens retrieved at 2 autopsies demonstrated graft union to host bone.

Conclusions

A structural allograft provides a stable and durable reconstruction of a tibial bone deficiency. At a mean of 95 months postoperatively, we found no instance of graft collapse or aseptic loosening associated with the structural allograft. We recommend the use of a structural allograft for the management of severe tibial bone deficiency at the time of revision total knee arthroplasty.

Copyright remains with the authors and publisher.

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