Liner exchange and bone grafting: rare option to treat wear & lysis of stable TKAs

Abstract

Background: Liner exchange and bone grafting are commonly performed for wear and osteolysis around well-fixed modular acetabular components that otherwise would require structural allografting and revision THA. However, liner exchange in the face of substantial lysis around TKA has been performed rarely with reports of failure rates of up to 25% at 3 year followup.

Questions/purposes: We therefore evaluated the technique of liner exchange and bone grafting for cases of wear and extensive osteolysis around TKAs in which the components were well-fixed and well-aligned to determine (1) rerevision rates; (2) fate of the bone graft; (3) radiographic loosening rates; and (4) functional scores.

Methods: We retrospectively reviewed 22 patients (25 knees) who underwent revision TKA with exchange of the modular polyethylene insert and bone grafting in cases with well-fixed components and large areas of osteolysis (up to 54 cm(2) on a single projection) at the time of revision. The average area of osteolysis was 21 cm(2) and 10 cm(2) on the AP projection of the femur and tibia, respectively. On the lateral projection, the average area of osteolysis for the femur and tibia was 22 cm(2) and 9.3 cm(2). Minimum clinical and radiographic followup was 22 and 22 months (average, 61 and 59; range, 22-142 and 22-130, respectively).

Results: One of the 25 knees was revised for aseptic loosening or recurrence of osteolysis. On radiographs, 84.6% and 70% of femoral and tibial osteolytic lesions, respectively, showed evidence of complete or near complete graft incorporation. The remaining lesions showed evidence of partial graft incorporation with the exception of one tibial lesion, which was in the revised case. All other components were well fixed with no evidence of radiographic loosening.

Conclusions: In this selected series of cases with extensive osteolysis around well-fixed and well-aligned TKAs, liner exchange and bone grafting provided durable midterm results with extensive graft incorporation.

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

Fig. 1A–C

Technique of débridement of the osteolytic lesion with bone grafting is shown. (A) A bone window created to gain access to the osteolytic lesion; (B) curettement of the osteolytic lesion through a bone window; (C) filling of the osteolytic defect with graft material under fluoroscopic control.

Fig. 2A–D

Radiographs of a 45-year-old woman who underwent liner exchange and bone grafting of a femoral osteolytic lesion are shown. (A) The prerevision radiographs are shown; (B) the postrevision lower limb alignment view; (C) the 7-year postrevision radiographs, AP view and (D) lateral view, demonstrate restoration of anatomic alignment and complete incorporation of bone graft. At 7-year followup, the patient’s Knee Society clinical and functional scores were 95 and 90, respectively, with a ROM of 0° to 125°.