gms | German Medical Science

Loosening of total knee replacement may lead to extensive bony defects. Reconstruction of a bone deficient situation is a major challenge in revision total knee arthroplasty and standard implants will neither fit the size of these defects nor they will lead to further peripheral defects of bone stock worsening the situation if renewed loosening occurs. We tried to use nonsolid allograft for biologic reconstruction. Our purpose was to study if this kind of revision surgery guarantees a solid, stable and patient sufficient situation.

We performed a retrospective study of 37 cemented, long stemed hinged knee prostheses with a mean age of 65.5 (34.7 - 81.9) years. Average follow-up was 4.1 (2.0 - 9.8) years. 6 patients died of unrelated causes prior to follow-up examination consisting a questionaire and standardized radiographs to evaluate allograft incorporation and indices of loosening.

2 cases had a revision after 23.0 and 74.5 months including an identic exchange of the corresponding femoral or tibial component whilst presenting a still intact former reconstruction. 2 cases failed 8 and 19 month after revision surgery without any further complications since then. 57 percent of the patients complained pain and over two thirds were not satisfied with their results by time of follow-up.

Extensive bone loss in revision total knee arthroplasty complicates salvage operations. Allograft reconstruction is an alternative to be seen critically from our point of view. Indication should be defined only with strict respect to methodical guidelines.