Morselized bone grafting in revision arthroplasty of the knee: A retrospective analysis of 34 reconstructions after 2–9 years

Abstract

Background and purpose Loosening of a total knee replacement may lead to loss of bone, requiring biological reconstruction at revision arthroplasty. Good results have been reported from revision arthroplasty of the hip using impaction bone grafting. We report our results of revision total knee arthroplasty using the same technique.Patients and methods We retrospectively analyzed 30 patients (involving 34 knees) with a mean age of 63 (34-81) years who, between 1994 and 2002, underwent revision arthroplasty of the knee using hinge or rotational knee prostheses (Link) and impaction bone grafting. The average follow-up was 4 (2-9) years and included a questionnaire, a clinical examination, and standardized radiographs.Results 25 patients were satisfied with their results. 10 patients reported no impairment in their activities of daily living attributed to their operation and did not need any walking support. In 5 patients, there were no clear radiographic signs of incorporation of the graft but that did not compromise the outcome. 5 other patients had complications due to aseptic loosening of their prostheses with radiographic failure of the graft, leading to a periprosthetic fracture in 2 cases.Interpretation Our results with impaction bone grafting in knee revision arthroplasty appear to be similar to those obtained by the same technique in revision hip surgery.

Short and mid term results of revision total knee arthroplasty with Global Modular Replacement System

“…Standard prostheses with metal augments, cement, allograft or bone grafts can be used for small segmental bone defects 1011. However, in cases of severe bone loss or complete clinical insufficiency of all major ligaments (medial or lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament), increased constraint is required, from a posterior stabilized prosthesis to a condylar constrained knee, or a rotating hinge device 1213.…”

A sliding stem in revision total knee arthroplasty provides stability and reduces stress shielding

“…There have only been a few reports of genuine impaction bone grafting in revision TKA (Ullmark and Hovelius 1996, Heyligers et al 2001, Lonner et al 2002, Lotke et al 2006, Steens et al 2008). Ullmark and Hovelius (1996) published the first description of the technique.…”

“…They essentially adopted the Slooff-Ling hip concept of a short stem totally surrounded by graft and cemented in situ (Gie et al 1993). Although the early clinical results of IBG in revision TKA have been promising (Ullmark and Hovelius 1996, Bradley 2000, Heyligers et al 2001, Lonner et al 2002, Lotke et al 2006, Steens et al 2008), the mechanical stability of the reconstruction of bicondylar defects with IBG has not been described. Our study shows that a stable reconstruction of uncontained bicondylar femoral defects could be created with IBG and a TKA with a thin stem extension.…”

Granuloma debridement and the use of an injectable calcium phosphate bone cement in the treatment of osteolysis in an uncemented total knee replacement

“…Cementation would have had the advantage of providing immediate stability [15,16], though would not have functioned as a biological scaffold, and might have caused thermal necrosis of the surrounding bone possibly leading to further osteolysis [17,18]. Autologous bone grafting was also considered because of its biological advantages, as well as its proven record in dealing with small tibial bony defects [19], and with impaction grafting in knee and hip revision arthroplasty [20]. …”