The management of bone defects in revision total knee arthroplasty.

The number of failed total knees with large bone defects is increasing. This is related to the large number of total knee arthroplasty procedures that are being performed in an increasingly active patient population. Long-term results are needed to compare clinical outcome and survivorship of allograft reconstruction versus custom prosthetic components. A benefit to using allograft reconstruction is that the bone deficiency is not increased as occurs with custom devices, and may be decreased with incorporation of the graft. In our current economic climate there are advantages to using allografts, despite costs as high as $1,600 for processing of a proximal or distal femur. In comparison, custom prostheses are not as cost effective. A material that can unite and gradually incorporate with host bone increases the potential for long-term success. Allograft may be used as part of a reconstructive armamentarium for total knee arthroplasty. Allografts are not implants and must be used as physiologic material. The early results are comparable or superior to traditional methods of reconstruction. The augmented bone stock in allograft knees remains a theoretical advantage and may facilitate subsequent revisions.