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Limitations of Structural Allograft in Revision Total Knee Arthroplasty

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Clinical Orthopaedics and Related Research

Abstract

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.

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

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Acknowledgments

We thank Cathy Schleck for statistical analyses.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Ryan D. Bauman MD, David G. Lewallen MD & Arlen D. Hanssen MD

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  1. Ryan D. Bauman MD
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  2. David G. Lewallen MD
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  3. Arlen D. Hanssen MD
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Correspondence to David G. Lewallen MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has 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.

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Bauman, R.D., Lewallen, D.G. & Hanssen, A.D. Limitations of Structural Allograft in Revision Total Knee Arthroplasty. Clin Orthop Relat Res 467, 818–824 (2009). https://doi.org/10.1007/s11999-008-0679-4

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  • DOI: https://doi.org/10.1007/s11999-008-0679-4

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