Abstract
Impaction grafting has been used for both femoral and acetabular defects quite successfully for over 15 years. Sloof, Ling and others have demonstrated consistent remodelling of the morselised allograft in both locations as well as long-term survivorship in a high percentage of difficult revisions. The application of this concept to the knee is somewhat novel, although there have been a few scattered reports, but bone loss in revision knee surgery can also be profound. Like its counterpart in the hip, it relies heavily on meticulous technique for success. Key aspects of the technique: the use of crushed cancellous fresh frozen allograft; tight packing of the graft; containment of the graft with mesh when necessary; and secondary packing with proper instruments to ensure stability of and load bearing on the graft. The need for polished tapered stems remains in question, as RSA techniques in the hip have indicated that motion is less commonly linked with stability. Subsidence, mechanically speaking, will not be tolerated as well at the knee as in the hip and will, in most cases, lead to loosening or gap mismatching with accompanying instability.
Patients with greater than 50% loss of cancellous bone stock volume, tibial height at or below the fibular head, and/or distal femoral loss to or beyond the epicondyle(s) are ideal candidates. Augments usually have difficulty restoring the joint line in these massive loss cases and usually add nothing that can potentially serve as a foundation for new implants should yet another revision be necessary in a patient’s lifetime. Impaction grafting at the knee has the potential to augment the bone stock in such cases substantially.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
