, Volume 469, Issue 1, pp 154-159
Date: 31 Aug 2010

Liner Exchange and Bone Grafting: Rare Option to Treat Wear & Lysis of Stable TKAs

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Topic
Knee

Abstract

Background

Liner exchange and bone grafting are commonly performed for wear and osteolysis around well-fixed modular acetabular components that otherwise would require structural allografting and revision THA. However, liner exchange in the face of substantial lysis around TKA has been performed rarely with reports of failure rates of up to 25% at 3 year followup.

Questions/purposes

We therefore evaluated the technique of liner exchange and bone grafting for cases of wear and extensive osteolysis around TKAs in which the components were well-fixed and well-aligned to determine (1) rerevision rates; (2) fate of the bone graft; (3) radiographic loosening rates; and (4) functional scores.

Methods

We retrospectively reviewed 22 patients (25 knees) who underwent revision TKA with exchange of the modular polyethylene insert and bone grafting in cases with well-fixed components and large areas of osteolysis (up to 54 cm2 on a single projection) at the time of revision. The average area of osteolysis was 21 cm2 and 10 cm2 on the AP projection of the femur and tibia, respectively. On the lateral projection, the average area of osteolysis for the femur and tibia was 22 cm2 and 9.3 cm2. Minimum clinical and radiographic followup was 22 and 22 months (average, 61 and 59; range, 22–142 and 22–130, respectively).

Results

One of the 25 knees was revised for aseptic loosening or recurrence of osteolysis. On radiographs, 84.6% and 70% of femoral and tibial osteolytic lesions, respectively, showed evidence of complete or near complete graft incorporation. The remaining lesions showed evidence of partial graft incorporation with the exception of one tibial lesion, which was in the revised case. All other components were well fixed with no evidence of radiographic loosening.

Conclusions

In this selected series of cases with extensive osteolysis around well-fixed and well-aligned TKAs, liner exchange and bone grafting provided durable midterm results with extensive graft incorporation.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One or more of the authors has received royalties from DePuy (JJC); has received research/institutional support from DePuy (DDG); has received research/institutional support from Wright Medical (JCC); and has received royalties from Zimmer and Wright Medical (WJM).
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the University of Iowa, Iowa City, IA, USA.