Treatment of Severe Bone Defects During Revision Total Knee Arthroplasty with Structural Allografts and Porous Metal Cones—A Systematic Review

Abstract

Aseptic loosening and focal osteolysis are the most common reasons for knee arthroplasty failure. The best treatment remains unclear. We reviewed the literature on the treatment of revision knee arthroplasty using bony structural allografts (476 cases) and porous metal cones (223 cases) to determine if a difference in the revision failure rates was discernable. The failure rates were compared using a logistic regression model with adjustment for discrepancies in FU time and number of grafts used (femoral, tibial, or both). In this analysis, the porous implant shows a significantly decreased loosening rate in AORI 2 and 3 defects. The overall failure rate was also substantially lower in the porous metal group than the structural allograft group; little difference in the infection rates was noted.

Contemporary bone loss options: Rebuild, reinforce, and augment

“…In addition, it carries a risk of disease transmission, deep infection, and graft non-union, resorption, fracture, or collapse [14]. In a recent systematic review on structural allografts in revision TKA, a total of 551 bulk allografts were used in 476 revision TKAs at a mid-term follow-up of 5.9 years [15]. The cumulative results demonstrated a 6.5% reoperation rate for loosening or fracture of the graft, a 3.4% rate of aseptic loosening of the prosthesis, and a 5.5% rate of deep infection.…”

In Response to “Treatment of Severe Bone Defects During Revision Total Knee Arthroplasty with Structural Allografts and Porous Metal Cones — A Systematic Review”

“…We are very interested in post-publication commentaries by the readership and have carefully examined the Letter to the Editor in regard to our recently published article entitled "Treatment of Severe Bone Defects During Revision Total Knee Arthroplasty with Structural Allografts and Porous Metal Cones-A Systematic Review" [1].…”

“…We read with interest the latest article published in the Journal of Arthroplasty titled "Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones -a systematic review" by Nicholas A. Beckmann et al [1]. We, however, would respectfully like to highlight certain important concerns in methodology of the systematic review and its conclusions.…”

“…

We read with interest the latest article published in the Journal of Arthroplasty titled "Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones -a systematic review" by Nicholas A. Beckmann et al [1]. We, however, would respectfully like to highlight certain important concerns in methodology of the systematic review and its conclusions.

Number of Knees, Grafts and Cones

The authors included seventeen published articles on structural allograft in revision total knee arthroplasty in which 551 bulk allografts were used during 476 revision cases.

…”

Macrophage responses to implants: prospects for personalized medicine

“…In the United States alone, there are .1 million such surgical operations performed each year [34]. Some of these patients need to undergo a revision surgery, usually related to aseptic loosening associated with periarticular osteopenia, focal osteolysis, and infection [35]. At the heart of these complications is inflammation.…”