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. 2009 Mar;467(3):818-24.
doi: 10.1007/s11999-008-0679-4. Epub 2009 Jan 7.

Limitations of structural allograft in revision total knee arthroplasty

Ryan D Bauman  1 , David G Lewallen, Arlen D Hanssen
Affiliations

Limitations of structural allograft in revision total knee arthroplasty

Ryan D Bauman et al. Clin Orthop Relat Res. 2009 Mar.

Abstract

Management of large bone defects in total knee arthroplasty (TKA) usually has involved modular prostheses with metal augments, structural allografts, and megaprostheses. We retrospectively reviewed the outcome of treatment of major bone defects for 74 patients (79 knees) who had revision TKAs with structural allografts; nine patients were lost to followup before 5 years, leaving 65 patients (70 knees, or 88%) followed for a minimum of 5 years or until revision or death. Medical records, radiographs, patient surveys, and correspondence were used for all data. Sixteen patients (22.8%) had failed reconstructions and underwent additional revision surgery; eight of the 16 were secondary to allograft failure, three were secondary to failure of a component not supported by allograft, and five were secondary to infection. In patients not requiring revision surgery, the Knee Society score improved from 49 preoperatively to 87 postoperatively. We observed revision-free survival of 80.7% (95% confidence interval, 71.7-90.8) at 5 years and 75.9% (95% confidence interval, 65.6-87.8) at 10 years. Our data support the selective use of structural allograft for large cavitary defects encountered during TKA. However, the rates of complications and reoperations suggest efforts to improve results or develop more durable alternative methods are warranted for these challenging reconstructions.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1A–D
Fig. 1A–D
(A) Anderson Orthopaedic Research Institute (AORI) Type 1 deficiency has intact metaphyseal bone. (B) A Type 2a deficiency involves metaphyseal deficiency of only one condyle or plateau, and (C) a Type 2b deficiency involves metaphyseal deficiency of both condyles or plateaus. (D) A Type 3 deficiency has massive cavitary defects with severe metaphyseal deficiency. (Reprinted with permission from Mulhall KJ, Ghomrawi HM, Engh GA, Clark CR, Lotke P, Saleh KJ. Radiographic prediction of intraoperative bone loss in knee arthroplasty revision. Clin Orthop Relat Res. 2006;446:51–58.)
Fig. 2
Fig. 2
The Kaplan-Meier 5- and 10-year survivorship rates with revision for any reason were 80.7% (95% confidence interval, 71.7–90.8) and 75.9% (95% confidence interval, 65.6–87.8), respectively.
Fig. 3
Fig. 3
The Kaplan-Meier 5- and 10-year survivorship rates with revision secondary to allograft failure only were 87.4% (95% confidence interval, 75.9–96.1) and 87.4% (95% confidence interval, 75.9–96.1), respectively.
Fig. 4A–C
Fig. 4A–C
The radiographs show (A) a periprosthetic femur fracture that was treated with (B) revision TKA using a distal femoral allograft. (C) The patient’s radiograph 42 months after revision shows a symptomatic distal femoral allograft nonunion that underwent revision.
Fig. 5A–B
Fig. 5A–B
A 63-year-old patient experienced failure secondary to allograft resorption 18 months after femoral head allografting to the tibial plateau. (A) Allograft resorption is evident in the medial tibial plateau. (B) A radiograph obtained 30 months postoperatively shows a tibial tray fracture secondary to allograft resorption. The tibial tray fracture was seen after prosthesis removal.
See this image and copyright information in PMC

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