Between 1985 and 1991, 15 patients underwent structural allografting a
s part of revision total knee arthroplasty. All patients had large seg
mental, cavitary, or combination defects of the femur and/or tibia. Se
ven distal femurs and 12 proximal tibias required allografting. Patien
ts were evaluated with physical examination, radiographs, and The Hosp
ital for Special Surgery knee rating scale. Three patients died, leavi
ng 15 allografts for follow-up study. The average age at surgery was 6
3 years. The follow-up period averaged 47 months (range, 30-101 months
). Average range of motion before surgery was 4 degrees to 93 degrees,
and after surgery, 2 degrees to 104 degrees Average knee score was 47
before and 86 after surgery. Preoperative alignment averaged 5 degree
s varus, ranging from 25 degrees valgus to 20 degrees varus, and posto
perative alignment averaged 4 degrees valgus, ranging from neutral to
6 degrees valgus. All patients, except one, had improvement of pain an
d stability. All of the 15 allografts healed to host-bone and 13 showe
d evidence of incorporation. There were no infections or fractures of
the allografts. One complication directly related to the allograft occ
urred; that patient had a tibial component fracture over a proximal ti
bial allograft 3 years after surgery. Three other complications occurr
ed. One was tibial loosening in a patient who received a distal femora
l allograft, the second was a proxi mal tibial fracture in a patient w
ho received a distal femoral allograft, and the third was an intraoper
ative patellar tendon avulsion. These results suggest that structural
allografting can provide a satisfactory method of managing large bone
defects in the failed total knee arthroplasty.