The Ranawat Award. Histology of nine structural bone grafts used in total knee arthroplasty

The cross section radiographs and histology of nine bone grafts were examined to determine whether grafts are durable enough to support a total knee implant when the load is shared by host bone, graft bone, and a stemmed component. All cases had cemented total knee arthroplasties with stemmed components adjacent to bulk grafts. The cases included autografts and allografts, which had been in situ for an average of 41 months (range, 20-62 months). Seven of the grafts were retrieved postmortem from three patients (four knees), and two were retrieved at revision surgery from one patient. The allografts all were intact, but had not revascularized. The autografts were viable bone. New bone was being laid down on the dead graft bone at the periphery of the allografts. No change in the bone to cement interface, no graft collapse, no development of radiolucent lines, and no component loosening occurred in these cases. The promising clinical results of bone grafts in total knee arthroplasties were confirmed by the examination of these grafts at the cellular level. Using stemmed components in bone grafted knee reconstructions may have increased graft durability and protected the grafts from fatigue failure.