Impaction bone grafting using fresh-frozen femoral head addressing severe bone defect in complex primary and revision TKA: A technical note

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Radiology

Background:

• Severe tibial and/or femoral bone defects present significant challenges in complex primary and revision total knee arthroplasty (TKA).
• Existing reconstruction methods include adjustable augments, porous metal components, and cement-and-screw techniques.
• Impaction bone grafting (IBG) is less documented but offers a potential solution.

Purpose of the Study:

• To describe the technique of impaction bone grafting (IBG) for managing severe bone defects in total knee arthroplasty (TKA).
• To evaluate the clinical and radiographic effectiveness of IBG in complex primary and revision TKA cases.

Main Methods:

• Utilized fresh-frozen femoral head allograft (structured or morselized) for impaction bone grafting.
• Compacted allograft into femoral or tibial cavitary defects.
• Followed by cementation of a stemmed TKA implant.

Main Results:

• Successfully applied IBG in three cases: one complex primary TKA and two revision TKAs (tibial and femoral reconstruction).
• Clinical and radiographic evidence demonstrated successful osseointegration at the 5-year follow-up.
• IBG proved effective for both tibial and femoral reconstruction.

Conclusions:

• Impaction bone grafting (IBG) is a viable technique for managing severe bone defects in total knee arthroplasty (TKA).
• IBG demonstrates effectiveness in both complex primary and revision TKA scenarios.
• Long-term osseointegration supports IBG as a reconstructive option.