Introduction and Objectives: There are knee prostheses that are specifically designed for the treatment of extreme cases of surgical revision of cases with large bone losses. These are hinged systems that provide greater stability and have a wide range of components to reconstruct bone defects Experience with this type of prosthesis is usually limited, due to the fact that it is used in complex and sporadic cases. Our aim is to review the results obtained with the implant of this prosthesis in our unit.

Materials and Methods: From June 2000 until March 2008 we implanted 10 salvage knee prostheses (5 TKR OSS, 5 TKR FINN). These procedures were carried out in 6 women and 4 men of 33 to 77 years of age. Indications for these procedures were many, with predominance of revision surgery of septic knee, bone tumors and failure of an infected osteosynthesis.

Results: We achieved pain relief in 7 patients: Mean morbidity > 45° in 7 cases. And 90% of the patients were satisfied.

Discussion and Conclusions: Large bone defects are difficult to reconstruct, especially when a joint is affected. Revision surgery is difficult and has poor results. Knee salvage prostheses are capable of providing a stable non-painful knee in severely incapacitated patients. We had few complications and we hope to have more cases and be able to carry out a longer follow-up of the ones we had. We are optimistic and we have named this prosthesis ‘the third knee prosthesis’.

Introduction and Objectives: Septic non-union can present a variety of problems for the surgeon, the most common being loss of bone continuity and persistence of infection. When conventional treatments fail we begin to use new bone tissue engineering techniques. The aim of this study is to present our experience over the last 5 years with 50 cases of infected non-union in which we used BMP-7.

Materials and Methods: Between 2002 and 2007 we used BMP-7 in 50 patients according to the protocol established by Friedlaender in 2001. Each patient was treated with allograft and BMP-7 and the same surgical technique was used in every case. Follow-up exams were carried out every 2 months with different control X-rays, analysis and cultures were performed to assess the evolution of consolidation and the end of infection.

Results: We achieved the desired consolidation in almost 70% of cases with good functionality of the affected limbs and freedom from infection. On the other hand, in 30% of cases we did not achieve expected consolidation and we saw that infection still persisted.

Discussion and Conclusions: The most critical and influential parameters affecting the end-result of treatment of infected non-union with BMP-7 are persistence of infection, poor vascularization, inadequate stabilization, and defective coverage of the subcutaneous tissue adjacent to the non-union focus.