Abstract
Aim: Bone loss in failed total knee arthroplasty can be managed by various techniques. This paper presents the ten year experience of one surgeon using morselized impacted allograft bone to revise failed knee replacements.
Method: Impacted bone was used in all knees having significant bone loss; no defects were replaced with augments or tumor replacement implants. Forty-eight knees having a minimum one year follow-up have been reconstructed. Maximum follow-up is ten years; the average time of follow-up is four years. Standard revision components were used in all except the first knee in this series. Except for two knees, monoblock LCS (J& J/DePuy) components were used. All knees received at least ninety cubic centimeters of bone graft. Nine knees were infected; eight were reconstructed in two stages and one in three stages.
Result: Two patients died and three were “lost” before one year follow-up could be obtained. There were four failures: two by component “spin-out”, one by fracture, and one by loosening. All failures have been satisfactorily reconstructed. None of the total knees revised for infection have failed. Histology obtained on the knees failing by fracture and loosening demonstrated viable, incorporated bone graft consistent with the findings of several authors retrieving impacted bone graft from hip reconstructions.
All patients ultimately benefited from the procedure. The average improvement in knee Society combined knee and function scores was over eighty-five points. The more functional patients experienced the most improvement.
Conclusion: This experience provides additional support for the use of impacted morselized allograft bone in reconstructing even large defects in failed knee arthroplasties.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
