The Journal of Bone and Joint Surgery, Vol 72, Issue 6 815-824, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
The incorporation of tibial allografts in total knee arthroplasty
AH Wilde, MS Schickendantz, BN Stulberg and RT Go
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Ohio 44195-5027.
Twelve knees in ten patients had revision total knee replacement with
insertion of an allograft for a large tibial defect. The knees were
retrospectively evaluated at an average of thirty-two months (range,
twenty-five to fifty-one months) by clinical examination, radiography,
planar bone scintigraphy, and single-photon-emission computed tomography.
The average age of the patients was sixty-two years (range, fifty-four to
seventy-nine years). A constrained total-condylar prosthesis was used for
all revisions. A contained tibial defect was present in five knees, and
seven knees had an uncontained defect that was treated with a massive
composite structural allograft, five of which were secured with internal
fixation. The knee scores improved from an average of 51 points before
operation to an average of 87 points post-operatively. Seven knees had a
score of 85 points or more and were considered to have an excellent
clinical result. Two knees had a good result, with scores of 77 and 72
points. One knee had another revision because of painful non-union of a
medial structural graft, and the result in that knee was considered a
failure. The average range of motion improved from 84 degrees to 105
degrees. There were no deep infections, and no graft showed evidence of
fracture or collapse. Radiographs demonstrated complete incorporation of
the graft in eleven of the twelve knees at an average of twenty-three
months after operation. Single-photon-emission computed-tomography scans
showed uniform activity in the area of the graft in four of the five knees
that were studied.
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