Impaction Bone Grafting in Revision Total Knee Arthroplasty-Using Mesh and Cone to Contain the Defect: A Report of 3 Cases.

Uncontained tibial bone defects are a challenge in revision total knee arthroplasty. The present study reports on the results of a modified surgical technique for impaction bone grafting using metaphyseal cones and wire mesh. Three patients (2 male, 1 female; average age: 71.3 years) underwent revision total knee arthroplasty. All patients presented with uncontained medial tibial bone defects, one of the patients with an additional posterior cortical tibial split fracture. All cases were treated with a metaphyseal cone and outside mesh to create a contained defect. Between the mesh and cone, fresh frozen cancellous chips mixed with β-tricalcium phosphate were impacted. No evidence of loosening or osteolysis was present at 3.6-year follow-up. Impaction bone grafting using an outside mesh and inside cone for defect containment provides a durable reconstruction of tibial bone defects.