Allograft reconstruction in total knee arthroplasty

Stockley, I; McAuley, J.P.; Gross, A E

doi:10.1302/0301-620x.74b3.1587885

Cited by 101 publications

(31 citation statements)

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“…Conversely, allografts have potential disadvantages such as possible nonunion, resorption, fracture, prolonged surgical time, potential for disease transmission, and an increased susceptibility to infection [2,6,10,12,16,17]. Reports of nonunion range from 0% to 4% and rates of infection range from 0% to 10% [1,2,8,10].…”

Section: Introductionmentioning

confidence: 99%

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Bauman¹,

Lewallen

Hanssen³

2009

Clinical Orthopaedics &Amp; Related Research

129

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Management of large bone defects in total knee arthroplasty (TKA) usually has involved modular prostheses with metal augments, structural allografts, and megaprostheses. We retrospectively reviewed the outcome of treatment of major bone defects for 74 patients (79 knees) who had revision TKAs with structural allografts; nine patients were lost to followup before 5 years, leaving 65 patients (70 knees, or 88%) followed for a minimum of 5 years or until revision or death. Medical records, radiographs, patient surveys, and correspondence were used for all data. Sixteen patients (22.8%) had failed reconstructions and underwent additional revision surgery; eight of the 16 were secondary to allograft failure, three were secondary to failure of a component not supported by allograft, and five were secondary to infection. In patients not requiring revision surgery, the Knee Society score improved from 49 preoperatively to 87 postoperatively. We observed revision-free survival of 80.7% (95% confidence interval, 71.7-90.8) at 5 years and 75.9% (95% confidence interval, 65.6-87.8) at 10 years. Our data support the selective use of structural allograft for large cavitary defects encountered during TKA. However, the rates of complications and reoperations suggest efforts to improve results or develop more durable alternative methods are warranted for these challenging reconstructions.

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Section: Introductionmentioning

confidence: 99%

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Bauman¹,

Lewallen

Hanssen³

2009

Clinical Orthopaedics &Amp; Related Research

129

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“…However, the bone defects are usually replaced either with bone grafts (autografts, allografts and xenografts), metallic augments, cement (Stockley et al 1992;Mow and Wiedel 1996;van Loon et al 1999;Completo et al 2008). Each one of these substitutes has certain advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

Terrier

Sedighi-Gilani

Ghias

et al. 2009

Computer Methods in Biomechanics and Biomedical Engineering

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Tibial bone defect is a critical problem for revision knee arthroplasty. Instead of using metallic spacer or cement, biodegradable scaffolds could be an alternative solution. A numerical model of a revision knee arthroplasty was thus developed to estimate the mechanical resistance of the scaffold in this demanding situation. The tibia, scaffold, and prosthesis were represented by simplified parameterised geometries. The maximal gait cycle force was applied asymmetrically to simulate a critical loading. Several parameters were analysed: 1) inter-individual variability, 2) cortical bone stiffness, 3) cortical bone thickness, 4) prosthesis fixation quality, and 5) scaffold thickness. The calculated scaffold strain was compared to its experimental ultimate strain. Among the tested parameters, failure was only predicted with scaffold thickness below 5 mm. This study suggests that biodegradable bone scaffolds could be used to fill bone defects in revision knee arthroplasty, but scaffold size seems to be the limiting factor.

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“…However, it has been speculated that the sustained release of antibiotics from bone cement may have adverse effects, and authors have argued for the use of biodegradable vehicles for antibiotic delivery (Hope et al 1989, van de Belt et al 2001. When there is loss of bone stock during revision of a loose hip or knee prosthesis, morselized cancellous allograft is impacted before implantation of the new prosthesis (Sloof et al 1984, Stockley et al 1992, Gie et al 1993, Benjamin et al 2001. There have been reports that cancellous bone can act as a carrier of antibiotics (Witsø et al 1999, 2000, 2002, Winkler et al 2000.…”

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confidence: 99%

High local concentrations without systemic adverse effects after impaction of netilmicin-impregnated bone

Witsø¹,

Persen²,

Benum³

et al. 2004

Acta Orthopaedica Scandinavica

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Background When cancellous bone is impregnated with antibiotics the subsequent release of antibiotics from the bone shows a high early release. Hence, impaction of large amounts of netilmicin-impregnated bone may cause toxic netilmicin values in serum.Patients and methods We studied kidney and otovestibular function after impacting 50 g of netilmicin-impregnated cancellous bone during revision hip or knee arthroplasty in 20 patients. The bone was impacted in the acetabulum (n = 8), proximal femur (n = 9) and distal femur/proximal tibia (n = 3). Serum creatinine concentration was measured and audiometry was performed before and after the operation. Netilmicin concentrations in serum, joint fluid, and in urine were recorded postoperatively at regular intervals. We analyzed pharmacokinetics in two study groups receiving bone impregnated with netilmicin (50 mL), at either 50 mg netilmicin/mL (group I) or 100 mg netilmicin/mL (group II).Results Neither netilmicin-induced renal toxicity, nor otovestibular toxicity was registered. Peak serum netilmicin values in group I and group II were 0.9 (0.5-1.3) mg/L and 1.8 (0.6-4.0) mg/L, respectively (p = 0.04). Peak netilmicin concentrations in wound drainage fluid in group I and group II were 237 (9-647) mg/L and 561 (196-1132) mg/L, respectively (p = 0.01). In both groups, netilmicin was recovered in urine samples for approximately 4 weeks.Interpretation 50 grams of cancellous bone impregnated with 100 mg/mL netilmicin solution was impacted in the hip or knee joint with no adverse effects. Extremely high local concentrations of netilmicin in

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Allograft reconstruction in total knee arthroplasty

Abstract: The allografts effectively filled large bone defects around the knee, lessening the need for custom-made and constrained prostheses.

Cited by 101 publications

References 0 publications

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

High local concentrations without systemic adverse effects after impaction of netilmicin-impregnated bone

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