Abstract
During the revision of a failed total knee implant, when large osseous defects are encountered, the surgeon has the following three options for managing severe bone loss: revision with a custom implant, revision with a rotating-hinge component, or reconstruction with an allograft and a long-stemmed revision component. An allograft reconstruction replaces the damaged bone, albeit with dead bone; whereas the other two options require additional bone to be removed. By using a bone defect classification system preoperatively, the surgeon estimates the extent of bone damage and orders the proper revision system and allograft material. A durable revision arthroplasty is achieved by using long-stemmed implants that provide axial stability, cementless stems that permit compressive loads, and step cuts that achieve rotational stability.
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