Cementless fixation issues in revision total knee arthroplasty.

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Immunology

Background:

• Massive solid allografts can exhibit variable outcomes, including collapse and necrosis, with immunocompatibility playing a key role in healing.
• Rejection is a significant factor in the survival of large allografts, and marrow elements in cancellous bone may provoke an inflammatory immune response.

Purpose of the Study:

• To evaluate the efficacy of morcellized cancellous bone allografts in reconstructing large bone defects.
• To compare the biologic behavior and clinical outcomes of morcellized allografts with those of block allografts.

Main Methods:

• Washing marrow from cancellous bone to reduce immunogenicity and soaking in antibiotic solution for slow release.
• Utilizing morcellized cancellous bone over finely ground bone for reconstruction of large bone stock defects.
• Ensuring adequate fixation and support of implants until graft consolidation.

Main Results:

• Morcellized allografts show rapid vascularization and ossification, forming a competent load-bearing structure.
• Clinical experience indicates rare migration of tibial components after reconstruction with morcellized allograft (2-5 years post-surgery).
• This technique provides long-term implant support, potentially reducing the need for repeat revisions.

Conclusions:

• Proper handling of bone grafts, including marrow removal and antibiotic treatment, is crucial for successful knee reconstructions.
• Morcellized cancellous bone allografts offer a viable and encouraging salvage procedure for large bone defects, outperforming structural allografts in certain applications.
• The vigorous biologic response and long-term stability suggest morcellized allografts are a reliable option for complex orthopedic reconstructions.