Structural allografting in revision total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Bone Reconstruction

Background:

• Morsellized cancellous grafts are successful for smaller defects in revision total knee arthroplasty (TKA).
• Large, noncontained osseous defects often necessitate the use of structural allografts in revision TKA.
• Early clinical outcomes for revision TKA with structural allografts show promise.

Purpose of the Study:

• To evaluate the efficacy of structural allografts in managing large osseous defects during revision TKA.
• To identify critical factors for successful allograft incorporation and long-term implant survival.
• To recommend surgical strategies for optimizing outcomes in complex revision TKA cases.

Main Methods:

• Review of clinical results from revision TKA procedures utilizing structural allografts.
• Assessment of allograft-host union rates and fixation methods.
• Analysis of factors influencing allograft integrity and load transmission.

Main Results:

• High rates of allograft-host union are achievable with adequate allograft fixation.
• Intramedullary stems engaging diaphyseal bone reduce load on the allograft, mitigating collapse risk.
• Encouraging early clinical results have been observed.

Conclusions:

• Structural allografts are a viable option for large osseous defects in revision TKA.
• Meticulous preoperative planning, surgical technique, and postoperative rehabilitation are essential for optimal results.
• Employing intramedullary fixation strategies is recommended to enhance allograft longevity.