Background: Fresh osteochondral allograft transplantation is a
treatment option for young patients with osteochondral lesions of the knee.
The present study evaluated the surgical complexity of, and the prevalence of
complications related to, total knee arthroplasty in patients who had had a
previous osteochondral graft transplantation.
Methods: A retrospective analysis was performed on thirty-three
consecutive patients (thirty-five knees) who underwent total knee arthroplasty
from 1974 to 2000 after having had a previous transplantation of a fresh
osteochondral allograft into the same knee. The mean duration of follow-up was
ninety-two months. Perioperative data were analyzed with regard to etiology,
preoperative impairment, intraoperative technical complications, early and
late postoperative complications, and postoperative functional and subjective
outcomes. The Knee Society clinical rating system was used for clinical
evaluation beginning in 1990.
Results: Four knees required additional techniques for exposure.
Three knees required stemmed components, one knee required a tibial augment,
and two knees required morselized grafts. The mean Knee Society objective
score (available for eighteen knees) improved from 34.7 preoperatively to 87.9
at the time of the latest follow-up, and the mean Knee Society function score
improved from 45 to 82. The mean range of motion of all knees improved from
85° to 105°. Six of the thirty-five knees underwent revision total
knee arthroplasty because of aseptic loosening, with two knees being revised
within two years after the index total knee arthroplasty.
Conclusions: Total knee arthroplasty after previous fresh
osteochondral allograft transplantation provides improvements in knee function
and range of motion, with manageable technical difficulties. Compared with
routine total knee arthroplasty, an increased rate of early revision can be
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.