The Use of Structural Allograft for Uncontained Defects in Revision Total Knee Arthroplasty

Clatworthy, Mark; Ballance, J.; Brick, Gregory W.; Chandler, Hugh P.; Gross, Allan E.

doi:10.2106/00004623-200103000-00013

Cited by 201 publications

(102 citation statements)

References 9 publications

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“…The Kaplan-Meier analysis reveals 5-and 10-year survival rates of 80.7% and 75.9%, respectively, using revision or removal as the end point. Our data appear consistent with those of others in terms of revision rates and complications (Table 5) [1,2,8,10]. Clatworthy et al [2] reported 50 patients with 52 revision TKAs with allografts at an average 8-year followup and reported a survival rate of 72% at 10 years.…”

Section: Discussionsupporting

confidence: 92%

“…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]. Revision TKA with structural allograft makes use of femoral heads, bulk tibia, or bulk distal femoral allografts to achieve mechanical stability for the implants.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 92%

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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“…Options have included the use of impaction bone-grafting [22,25,38,40,44], structural bulk allografts [7,11,14,16,17,28,31,39], and tumor-type megaprostheses [2]. Studies with structural allografts and tumor megaprostheses during revision knee arthroplasty have reported encouraging mid-term results, but the high number of complications is a concern.…”

Section: Discussionmentioning

confidence: 99%

“…Studies with structural allografts and tumor megaprostheses during revision knee arthroplasty have reported encouraging mid-term results, but the high number of complications is a concern. Complications with these techniques include infection, graft resorption, nonunion, failure of graft incorporation, concerns regarding disease transmission, aseptic loosening, and periprosthetic fracture [1,7,14,17,33]. Although the short-term results with tantalum cones have been promising [9,18,21,23,24,26,[34][35][36]42], to our knowledge, there have been no studies reporting mid-term outcomes with their use.…”

Section: Discussionmentioning

confidence: 99%

“…Major tibial and femoral bone defects, classified as Anderson Orthopaedic Research Institute (AORI) [10] Types 2B and 3, have been reconstructed using impaction bone grafting with or without mesh augmentation [22,25,38,40,44], structural or bulk allografts [7,11,14,16,17,28,31,39], modular metal augmentations of prostheses [15,32], and tumor-type megaprostheses [2]. 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].…”

Section: Introductionmentioning

confidence: 99%

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Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Martino

Santis

Sculco

et al. 2015

Clin Orthop Relat Res

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Background Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions. Questions/purposes We wished to determine the midterm (1) reoperation rates for septic and aseptic causes, (2) radiologic findings of osseointegration, and (3) clinical outcomes based on the Knee Society score in patients who underwent revision knee arthroplasty with tantalum cones for severe bone loss. Methods We retrospectively evaluated records of 18 patients (18 knees) who underwent revision knee arthroplasty with use of tantalum cones between 2005 and 2008; the primary indications for use of this approach were to reconstruct massive bone defects classified as Anderson Orthopaedic Research Institute Types 2B and 3. During this period, all defects of this type were treated with this approach and no cones were used for more-minor defects. A total of 26 cones (13 tibial and 13 femoral) were implanted. There were 12 female and six male patients with a mean age of 73 years (range, 55-84 years) at the time of revision. The indication for the revision included aseptic loosening (five patients) and second-stage reimplantation for deep infection (13 patients). Patients were followed for a mean of 6 years (range, 5-8 years). No patient was lost to followup. Clinical and radiographic outcomes were assessed with the Knee Society clinical rating system and radiographic evaluation system.

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Femoral Bone Defects in Revision Total Knee Arthroplasty

Katchky

Backstein

2021

Evidence‐Based Orthopedics

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The Use of Structural Allograft for Uncontained Defects in Revision Total Knee Arthroplasty

Cited by 201 publications

References 9 publications

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Femoral Bone Defects in Revision Total Knee Arthroplasty

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