Tibial osteolysis in cementless total knee arthroplasty. A review of 25 cases treated with and without tibial component revision.

Revision total knee arthroplasty was performed in 25 knees with tibial osteolysis that was identified radiographically and confirmed histologically. Eighteen knees had focal osteolysis in the medial tibial plateau, 2 in the lateral plateau, and 5 in both plateaus. Three surgical treatment options were used: (1) exchange of the modular tibial polyethylene insert with screw removal; (2) revision of the tibial component with curettage and optional grafting of the defect; (3) and full revision of all components. The clinical and radiographic results of partial and full revision remain excellent 2 to 6 years (mean, 41 months) postrevision arthroplasty for 23 knees. Clinical failure with pending revision occurred in 1 patient with polyethylene exchange without the removal of tibial fixation screws, and in 1 patient with progression of osteolysis adjacent to the femoral component 2 years after tibial component revision. Tibial defects have not progressed, and new lesions have not developed with simple curettage of the defect and removal of sources of particulate. Tibial baseplates remain radiographically stable. Component revision of the tibial component, femoral component, or both, required the insertion of long-stemmed revision components and frequently the use of major structural allografts. These revisions have faired well, although the long-term stability of components supported with major structural allografts is unknown.