Structural allografting in revision total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Musculoskeletal Research

Background:

• Revision total knee arthroplasty (TKA) often involves significant bone defects.
• Managing these defects is crucial for successful revision surgery outcomes.
• Structural allografts offer a potential solution for bone reconstruction.

Purpose of the Study:

• To evaluate the efficacy and outcomes of structural allografting in revision TKA.
• To assess bone healing, incorporation, and functional recovery after allograft use.
• To report complications associated with structural allografting in this context.

Main Methods:

• A retrospective study of 15 patients undergoing revision TKA with structural allografting between 1985 and 1991.
• Allografts were used for large segmental, cavitary, or combined femoral and/or tibial defects.
• Patient evaluation included physical examination, radiographs, and The Hospital for Special Surgery (HSS) knee rating scale.

Main Results:

• Average follow-up was 47 months. Average range of motion improved from 4°-93° to 2°-104°. Average HSS knee score improved from 47 to 86.
• All 15 allografts healed to host bone, with 13 showing incorporation. Pain and stability improved in all but one patient.
• Complications included one tibial component fracture, tibial loosening, proximal tibial fracture, and patellar tendon avulsion. No infections or allograft fractures occurred.

Conclusions:

• Structural allografting is a viable method for reconstructing large bone defects in revision TKA.
• The procedure demonstrated good bone healing, incorporation, and significant functional improvement.
• While complications can occur, structural allografting offers satisfactory results for complex revision cases.