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Total Knee Replacement in Previous Recipients of Fresh Osteochondral Allograft Transplants
Guy Morag, MD1; Anna Kulidjian, MD1; Paul Zalzal, BASc, MASc1; Nadav Shasha, BSc, MD1; Allan E. Gross, MD, FRCSC1; David Backstein, MD, MEd, FRCSC1
1 Mount Sinai Hospital, Suites 476A (G.M., A.K., P.Z., N.S., and A.E.G.) and 476D (D.B.), 600 University Avenue, Toronto, ON M5G 1X5, Canada. E-mail address for G. Morag: moragim@gmail.com. E-mail address for A. Kulidjian: akulidjian@rogers.com. E-mail address for P. Zalzal: paulzalzal@rogers.com. E-mail address for N. Shasha: drshasha@bezeqint.net. E-mail address for A.E. Gross: allan.gross@utoronto.ca. E-mail address for D. Backstein: david.backstein@utoronto.ca
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Orthopaedic Division, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(3):541-546. doi: 10.2106/JBJS.D.02816
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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 expected.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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