The Fate of Allogeneic Femoral Head Bone Grafts Using Varus-Valgus Constrained Total Knee Arthroplasty in Neuropathic Joints

Background: This study was conducted to assess the clinical and radiological results of total knee arthroplasty (TKA) with an allogeneic bone graft using varus-valgus constrained (VVC) prostheses in knees with severe bone defects and unstable neuropathy. Methods: This study included 20 knees of 16 patients who underwent TKA between August 2001 and January 2006 due to unstable knees with severe bone destruction resulting from neuropathic arthritis. At the time of surgery, the mean age of the patients was 56 years. The mean length of the follow-up period was 10.7 years. A VVC condylar prosthesis was used with an allogeneic femoral head graft to reconstruct large bony defects. Clinical results were evaluated using the Hospital for Special Surgery, Knee Society function, and Western Ontario and McMaster Universities Osteoarthritis scores. Three-dimensional computed tomography was used to evaluate the radiological parameters, which included the tibiofe-moral angle, loosening or osteolysis of components, and incorporation of the bone graft. Results: The preoperative mean Hospital for Special Surgery, Knee Society function, and Western Ontario and McMaster Universities Osteoarthritis scores were 40.5, 43.2, and 78.3, respectively, and these scores improved to 86.0, 64.6, and 33.8, respectively at the final follow-up. The mean postoperative alignment was 6.1 degrees of valgus angulation. One knee had instability, another knee had partial bony absorption, which was confirmed using 3-dimensional computed tomography, and the other 18 cases (90%) had satisfactory results. No cases experienced radiolucency, fracture, or infection. Conclusions: TKA with an allogeneic bone graft using a VVC prosthesis provides a viable option for the treatment of severe bone defects with soft-tissue insufficiency in neuropathic knee arthropathy. (C) 2016 Elsevier Inc. All rights reserved.