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

Abstract

A structural allograft provides a stable and durable reconstruction of a tibial bone deficiency. At a mean of ninety-five 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.

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

“…Furthermore, in our cohort, 13 of the 18 revisions were second-stage reimplantations for deep infection and yet, at this longer followup, had an infection rate comparable to those in the other reports. Our data compare unfavorably with the infection frequencies reported in the bulk allografts studies [1,6,11]. Bauman et al [1], Engh and Ammeen [11], and Chun et al [6] reported infection rates of 7% (five of 70), 4% (two of 46), and 4% (one of 27) respectively in their series.…”

“…Our data compare unfavorably with the infection frequencies reported in the bulk allografts studies [1,6,11]. Bauman et al [1], Engh and Ammeen [11], and Chun et al [6] reported infection rates of 7% (five of 70), 4% (two of 46), and 4% (one of 27) respectively in their series. However, only 9% to 11% of these reconstructions with bulk allografts were reimplantations for infection, whereas in our study 13 of the 18 revisions were second-stage reimplantations for deep infection.…”

“…Bauman et al [1], Engh and Ammeen [11], and Chun et al [6] reported reoperation rates of 23% (16 of 70), 19% (nine of 46), and 0% (0 of 27) in their series of 70, 46, and 27 knees respectively at minimum 5 years followup. Our revision frequency compares favorably with the reoperation frequencies reported by Bauman et al [1] and Engh and Ammeen [11], but unfavorable with the rate reported by Chun et al [6].…”

“…Options have included the use of impaction bone-grafting [22,25,38,40,44], structural bulk allografts [7,11,14,16,17,28,31,39], and tumor-type megaprostheses [2]. Studies with structural allografts and tumor megaprostheses during revision knee arthroplasty have reported encouraging mid-term results, but the high number of complications is a concern.…”

“…Major tibial and femoral bone defects, classified as Anderson Orthopaedic Research Institute (AORI) [10] Types 2B and 3, have been reconstructed using impaction bone grafting with or without mesh augmentation [22,25,38,40,44], structural or bulk allografts [7,11,14,16,17,28,31,39], modular metal augmentations of prostheses [15,32], and tumor-type megaprostheses [2]. Studies using structural allografts have reported numerous complications and minimum 5-year survivorship of 67% to 96% [1,6,7,14,17], whereas reconstructions with tumor-type megaprostheses have shown a 5-year survivorship of 68% [33].…”