Technique for impaction bone grafting of large bone defects in revision total knee arthroplasty

Impaction bone grafting is an important tool in managing the irregularly sized and shaped bone defects observed in revision total knees. The technique is described in detail and includes tightly packing cancellous bone chips about an intramedullary stem and into the periprosthetic bone defects, then fully cementing a component in place. If needed, wire mesh can be used to contain bone defects. Results to date in 42 patients with 2 to 7 years of follow up are reported. They show the average flexion was 111 degrees; the final Knee Society score was 89 points, and there were no mechanical failures. There were 2 infections and 2 late periprosthetic fractures. The results have been encouraging, and this technique remains our procedure of choice for managing large bone defects in revision knee surgery.