Failures in bipolar fresh osteochondral allograft for the treatment of end-stage knee osteoarthritis.
OBJECTIVE
Bipolar fresh osteochondral allografts (BFOA) recently became a fascinating option for articular cartilage replacement, in particular in those young patients non-suitable for traditional replacement because of age. While the use of osteochondral allografts for the treatment of focal osteochondral lesions in the knee is well established, their use in the treatment of end-stage arthritis is far more controversial. The purpose of this paper is to describe our experience in a series of seven patients who underwent a resurfacing of both tibio-femoral and patello-femoral joints by BFOA.


METHODS
From 2005 to 2007, seven patients (mean age 35.2 ± 6.3 years) underwent BFOA for end-stage arthritis of the knee. Patients were evaluated clinically, radiographically and by CT scan preoperatively and at established intervals up to the final follow-up.


RESULTS
No intra-operative complications occurred. Nevertheless, joint laxity and aseptic effusion, along with a progressive chondrolysis, lead to early BFOA failure in six patients, which were revised by total knee arthroplasty at 19.5 ± 3.9 months follow-up. Only one patient, who received the allograft to convert a knee arthrodesis, gained a satisfactory result at the last follow-up control.


CONCLUSIONS
BFOA in the knee joint still remains an inapplicable option in the treatment of post-traumatic end-stage arthritis of the young patient, due to the high rate of failure. Further studies are necessary in order to investigate the causes of failure and improve the applicability of this method. Still, after extensive counselling with the patient, BFOA may represent a salvage procedure aimed to revise scarcely tolerated knee arthrodesis.


METHODS
Retrospective case series, Level IV.
I Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna University, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy, sandro.giannini@ior.it.
S
S
Giannini
R
R
Buda
A
A
Ruffilli
G
G
Pagliazzi
A
A
Ensini
B
B
Grigolo
G
G
Desando
F
F
Vannini
D000328:Adult; D064591:Allografts; D001174:Arthrodesis; D002356:Cartilage / Q000637:transplantation*; D002358:Cartilage, Articular / Q000601:surgery*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D017211:Treatment Failure