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

¹ Anderson Orthopaedic Research Institute, 2501 Parker's Lane, Suite 200, Alexandria, VA 22306. E-mail address for D.J. Ammeen: Ammeen{at}aori.org

Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, Virginia

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy, a Johnson and Johnson company). Also, a commercial entity (Inova Health Care System) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Methods: From January 1985 through September 1999, one surgeon performed revision arthroplasty in forty-nine knees (forty-seven patients) with a severe tibial bone defect. The reasons for the revisions included polyethylene wear and osteolysis in twenty-four knees, aseptic loosening in seventeen knees, infection in five knees, and failure for another reason for three knees. Structural allograft was used alone in thirty-five knees and in conjunction with a tibial augment in fourteen knees. The mean age of the patients at the time of the revision arthroplasty with the allograft was sixty-seven years. The patients were assessed clinically with use of the Knee Society score and radiographically.

Results: The status of the implant was known for forty-six of the forty-nine knees in this study. It was unknown for one patient (one knee) who was lost to follow-up and for two patients (two knees) who died less than five years postoperatively. Four revision procedures in four patients failed and required a reoperation. Two of the failures were due to infection. At a mean of ninety-seven months postoperatively, the mean Knee Society clinical score was 84 points for the knees that had not had a reoperation due to failure. The mean arc of motion improved from 87° preoperatively to 103° at the most recent follow-up evaluation. Histological evaluation of specimens retrieved at two autopsies demonstrated graft union to host bone.

Conclusions: 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.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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