Revision total knee arthroplasty by impaction bone grafting

The presence of bone loss in a failed total knee arthroplasty can present a significant reconstructive challenge. Experience with the technique of using impacted morselized allograft with revision components having fixed stems is presented. Nineteen knees (21 patients) were reconstructed using impacted bone graft alone in 14 knees, bone graft plus methylmethacrylate in five knees (including one knee in which the replacement failed), and in three knees morselized bone graft was used in conjunction with structural bone allograft. Minimum followup ranged from 6 months to 62 months for the patients in the current series. These patients represent a relatively small, but growing portion of this surgeon's population of patients undergoing revision knee arthroplasty. Patients with large defects were selected for the study. Histologic specimens from the one failed knee arthroplasty revealed viable, incorporated bone graft. Excluding the replacement that failed, the average improvement in Knee Society combined knee and function scores was 87 points. The principles of revision and primary total joint arthroplasty are applied for achieving a stable implant. Specific to this technique, solid support of the implant-graft interface, graft-host bone interface, and the use of a tight, supportive stem is imperative. The author's experience provides additional support for the use of bone grafting techniques in patients with large bone defects who are undergoing revision total knee replacement.