Femoral bone grafting in primary and revision total knee arthroplasty

The purpose of this study was to evaluate the clinical and radiographic results of TKA's with morsellized and solid femoral bone grafting. From April 1989 to February 1996, 6 primary and 18 revision TKA's with femoral bone grafting were performed in 22 patients with an average age of 62 years. Eleven knees were affected by rheumatoid arthritis, 10 by osteoarthritis, 2 by osteonecrosis and one by hemophiliac arthropathy. The femoral bone defects were large in 12, medium in 9, small in 3, contained in 10 and uncontained in 14 cases. Reconstruction was done with impacted morsellized fresh frozen trabecular bone grafts in 13 knees, with solid bone grafts in 7 knees and with combined grafts in 4 knees. Twenty-one cases were clinically evaluated at an average of 38 months (range: 9-89 months). The average Knee Society knee score increased by 39 points to 85 points at follow-up. The average functional score increased by 22 points to 48 points. Two cases with solid femoral bone grafts failed due to aseptic loosening. There were no infections. Radiographic follow-up revealed osteopenia around the femoral component in 10 knees. Two knees showed circumferential radiolucency around the femoral stem, and 5 knees had minor radiolucency at the anterior part of the femoral component. Radiographic incorporation was present in 5 of the 6 cases that could be evaluated. Histologic analysis of two biopsies revealed incorporation of the morsellized bone graft. The authors advocate impacted morsellized bone grafting for contained and small-to-medium uncontained femoral bone defects in combination with cemented TKA.