Cementless revision total knee arthroplasty

This is a report of the outcome of cementless revision total knee arthroplasty (TKA), and describes the technique for bone grafting of massive femoral and tibial defects. The technique relies on rigid fixation of the implants using the remaining shell of distal femur and proximal tibia and the diaphysis of each bone for support of the implant. Fifty-six cementless revision TKAs in 56 patients were performed using cementless technique, long-stemmed components, and morselized allograft between April 1985 and April 1989. All knees had major loss of femoral and tibial bone stock. Fixation of the stemmed implants required firm seating on the rim of the femur and tibia. The stem engaged the isthmus of the bone to provide toggle control, and the screws fixed the implant firmly to bone. Two years after surgery, 30 (54%) of the patients had no pain, 17 (30%) had mild pain, five (9%) had moderate pain, and four (7%) had severe pain. All 56 knees had increasing radiodensity in the grafted areas one and two years postoperatively as compared with the one-month roentgenogram. All implants except two achieved stable fixation to bone. Alignment, stability, and comfort of the knee were all improved with cementless revision technique. The overall results of this study are encouraging. Bone stock was reliably reconstructed, and fixation during the short term appears to be durable.