Bone Grafting Methods and Allograft Prosthetic Replacement

Robert T. Trousdale

Key Concepts

Cancellous bone grafts and structural allografts remain an excellent choice for bone loss issues in selective cases during revision total knee arthroplasty (TKA).
Cancellous graft is a good choice when irregular defects are present or in ectatic bone when sleeves or cones are unlikely to get stability (Figure 65.1).
Intussusception allografts are a good choice in massive defects when sleeves or cones are unlikely to get stability (Figure 65.2).

Sterile Instruments and Implants

Routine revision knee components.
Press-fit or cemented stems to bypass bone defects.
High-speed burrs to prepare host bone and shape bulk allograft.

Figure 65.1 ▪ Anteroposterior radiograph showing marked osteolysis with periprosthetic fracture. A sleeve or cone would have difficulty getting good stability in such bone.

Figure 65.2 ▪ Anteroposterior radiograph showing marked tibial bone loss subsequently treated with intussusception allograft (See Figure 65.7).

Figure 65.3 ▪ Anteroposterior and lateral radiographs of a young patient anticipated to have substantial cavitary bone defects following implant removal.

Surgical Approaches