Impaction bone grafting using fresh-frozen femoral head addressing severe bone defect in complex primary and revision...

Severe tibial and/or femoral bone defects pose a significant challenge in both complex primary and revision total knee arthroplasty (TKA). Various techniques of reconstruction have been reported to address these defects, including adjustable augments, porous metal cones or sleeves, and the cement-and-screw technique. This technical note described the technique of impaction bone grafting (IBG), which involves using fresh-frozen femoral head allograft, that is structured or morselized and compacted into the femoral or tibial cavitary defect, followed by cementation of stemmed TKA implant. Although IBG is poorly documented in the literature and has been predominantly utilized in revision TKA, we presented its application in three cases: one complex primary TKA and two revision TKA (one involving tibial reconstruction and the other femoral reconstruction). Our report highlighted the effectiveness of IBG for both tibial and femoral reconstruction, with clinical and radiographic evidence confirming successful osseointegration at the 5-year follow-up. Therefore, IBG may be a viable technique for managing severe bone defects in both complex primary and revision TKA. LEVEL OF EVIDENCE: IV.