Reconstruction using femoral head allograft in revision total knee replacement

Abstract

Structural allografts may be used to manage uncontained bone defects in revision total knee replacement (TKR). However, the availability of cadaver grafts is limited in some areas of Asia. The aim of this study was to evaluate the mid-term outcome of the use of femoral head allografts for the reconstruction of uncontained defects in revision TKR, focusing on complications related to the graft. We retrospectively reviewed 28 patients (30 TKRs) with Anderson Orthopaedic Research Institute (AORI) type 3 bone defects, who underwent revision using femoral head allografts and stemmed components. The mean number of femoral heads used was 1.7 (1 to 3). The allograft-host junctions were packed with cancellous autograft. At a mean follow-up of 76 months (38 to 136) the mean American Knee Society knee score improved from 37.2 (17 to 60) pre-operatively to 90 (83 to 100) (p < 0.001). The mean function score improved from 26.5 (0 to 50) pre-operatively to 81 (60 to 100) (p < 0.001). All the grafts healed to the host bone. The mean time to healing of the graft was 6.6 months (4 to 16). There have been no complications of collapse of the graft, nonunion, infection or implant loosening. No revision surgery was required. The use of femoral head allografts in conjunction with a stemmed component and autogenous bone graft in revision TKR in patients with uncontained bone defects resulted in a high rate of healing of the graft with minimal complications and a satisfactory outcome. Longer follow-up is needed to observe the evolution of the graft.

No Difference Between Trabecular Metal Cones and Femoral Head Allografts in Revision TKA: Minimum 5-year Followup

“…We experienced a lower incidence of aseptic loosening in the allograft group than Bauman et al [3] and Clatworthy et al [8]; however, our duration of followup was relatively shorter. We encountered no failures secondary to graft resorption or aseptic loosening in this cohort in keeping with reports by Chun et al [7] and Wang et al [30]. One patient in this group fell and sustained a periprosthetic fracture 3 years after his revision.…”

“…Survivorship data with the use of allografts have been encouraging into the medium and long term. Wang et al [30] found no failures at 76-month followup in 30 knees in a group of Asian patients. Bauman et al [3], however, reported 81% survivorship at 5 years using allografts.…”

“…Bauman et al [3] reported a Knee Society Score (KSS) of 87 points in 70 knees treated with femoral head allografts at a minimum of 60 months followup. Wang and colleagues [30] reported a KSS score of 90 points, which was maintained up to 76 months postsurgery, whereas Chun et al's group [7] found that the Hospital for Special Surgery score was 83 points at an average of 107 months followup. The latter authors found that the time to graft union was 6 to 7 months, in keeping with the results of this study.…”

“…A number of options have been used for managing large bone deficiencies in revision TKA including allograft-prosthetic composites [10] with or without hinged prostheses [28] and impaction grafting [29]. Two techniques that have been described in the literature include the use of femoral head allografts [18,25,30] and, more recently, metaphyseal porous metal cones [16,19,20].…”

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

“…Studies using structural allografts have reported numerous complications and minimum 5-year survivorship of 67% to 96% [1,6,7,14,17], whereas reconstructions with tumor-type megaprostheses have shown a 5-year survivorship of 68% [33]. Although there have been studies reporting encouraging mid-term results with these treatment options [6,43], the best method has not been established [10].…”