title: Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones-a systematic review.
abstract: Aseptic loosening and focal osteolysis are the most common reasons for knee arthroplasty failure. The best treatment remains unclear. We reviewed the literature on the treatment of revision knee arthroplasty using bony structural allografts (476 cases) and porous metal cones (223 cases) to determine if a difference in the revision failure rates was discernable. The failure rates were compared using a logistic regression model with adjustment for discrepancies in FU time and number of grafts used (femoral, tibial, or both). In this analysis, the porous implant shows a significantly decreased loosening rate in AORI 2 and 3 defects. The overall failure rate was also substantially lower in the porous metal group than the structural allograft group; little difference in the infection rates was noted.
authors.affiliation: Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Beckmann
authors.affiliation: Department of Traumatology, Department of Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mueller
authors.affiliation: Department of Psychology, University of Copenhagen, Denmark.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gondan
authors.affiliation: Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Jaeger
authors.affiliation: Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reiner
authors.affiliation: Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Rudi G
authors.initials: RG
authors.lastname: Bitsch
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D001672:Biocompatible Materials; D016025:Bone Transplantation; D006801:Humans; D007720:Knee Prosthesis; D008670:Metals; D010014:Osteolysis / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D014184:Transplantation, Homologous
chemical_list: D001672:Biocompatible Materials; D008670:Metals
keywords: AORI; allograft; knee defects; knee revision arthroplasty; porous metal; tantalum