Revision total knee arthroplasty for major osteolysis

Twenty-eight knees in 26 patients underwent revision TKA requiring surgical management of major osteolytic defects. Three groups of osteolytic defects were identified based upon the degree of implant stability and the magnitude of bone loss. Outcome measures included the Knee Society Clinical Rating Score (KSCRS), visual analog pain score, and radiographs. At a mean follow-up of 48 months, the average knee pain scores, range of motion, and KSCRS improved (p<.05). Ninety-six percent of the knees demonstrated clinical and functional improvement. Radiographs for 24 revision TKA's (86 percent) demonstrated component stability and incorporation of both cancellous and structural allografts. Revision TKA for major osteolytic defects may be effectively performed using a variety of bone grafting techniques. Both morselized and structural bone grafting, in combination with stemmed components was successful in managing revision TKA in the setting of major osteolysis. Significant improvement in clinical and radiographic outcomes may be anticipated using these surgical techniques.