Impaction Grafting of Bone Defects in Revision Total Knee Arthroplasty

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Impaction grafting is a useful method to restore bone stock in contained tibial or femoral defects during primary and revision total knee arthroplasty. The authors describe a method to restore both contained and uncontained defects in deficient femoral and tibial condyles to reestablish the joint line without massive structural allograft. 1 Freeze-dried fine cancellous allograft is mixed with a small amount of a gelatin binder and a few drops of saline. In the hollow tibia, the plateau is prepared to the level with at least 50% of cortical rim. Bone is placed into the defect gradually as it is impacted with the special flat hammers until a flat and firm surface results. (The allograft packs down and becomes firm as it loses moisture.) When greater than 8-mm augments must be used restore the joint line or when there is more than 50% loss of the condyle, the senior author now uses a condylar cage. This is a porous coated cage that fits into the femoral trial implant and impacts on the distal femur. The porous tines of the cage set into bone during impaction and will allow bone ingrowth onto its surface. The cage will allow cancellous bone to grow within its contents, yet (hypothetically) will prevent collapse during creeping substitution. The final femoral implant is cemented over the prepared cage.

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