The results of the use of biological bone reconstruction in performing oncological revision knee replacement
Authors: Mikailov I. M. , Grigoriev P. V. , Kuzina A. A. 
Published: February 2025

Introduction. With an increase in revision surgeries for oncological knee prostheses replacement, one of the most significant challenges has been the need to address substantial intramedullary defects affecting the diaphysis and metaepiphyses in these patients. Our study is based on our experience with biological reconstruction methods used during such operations. We have developed both the methodology and necessary tools for its implementation, as well as conducted a comprehensive evaluation of its practical application results.

Aim. To assess the effectiveness of using biological bone reconstruction techniques in oncologic revision knee arthroplasty.

Materials and methods. A retrospective study included 57 patients who underwent revision total oncology knee arthroplasty with the use of biological reconstruction for intramedullary bone defects between 2017 and 2023, with a follow-up period of at least 12 months. Of these, 45 (78.9 %) were operated due to instability of the prosthetic components, while 12 (21.1 %) were treated in the second stage after spacer implantation due to infection.

Distribution of patients by location of bone defect: 26 (45.5 %) had femoral bone defects, 4 (7 %) had tibial bone defects, and 27 (47.4 %) had combined lesions involving both bones. Among the participants, 59.6 % were female and 40.4 % were male. The median age was 48 years (Q1–Q3) 39.00–57.00; min 23 – max 72), and the median follow-up time was 48 months (Q1–Q3 28.00–60.00; min 12 – max 150). Median blood loss values were 900 ml (Q1–Q3 700.0–1100.0; min 400 – max 2200), operation duration was 220 minutes (Q1–Q3 190.0–240.0; min 140 – max 300), and patient weight was 85 kg (Q1–Q3 77.0–95.0; min 56 – max 180).

We assessed complication risks, functional outcomes, and survival rates of the implants. All patients were divided into two groups: Group 1 (n = 37 or 64.9 %), operated before the introduction of new instruments, and Group 2 (n = 20 or 35.1%), operated after their introduction. Parameters such as operation duration and blood loss volume were compared between the groups.

Results. Over the entire observation period from 2017 to 2024, three cases (5.3%) of complications were identified. Bone density assessment in the bone graft zone was performed via CT scan six months postoperatively, yielding a mean value of 690 HU (Q1–Q3 570.0 – 790.0; min 340 – max 980).Analysis of lower limb function dynamics according to the MSTS scale pre- and post-operation revealed statistically significant improvements (p <0.001) (using Wilcoxon’s test).Five-year survival rate of knee prostheses after revision arthroplasty was 96 %.To analyze the effectiveness of introducing the newly developed instrumentation, we studied blood loss and operative times with and without its use. Using the instrumentation significantly reduced blood loss (p <0.001) and operative time (p <0.001) as determined by Mann-Whitney U-tests.

Conclusion. The five-year survival rates for constructs in patients undergoing surgery with biological bone reconstruction are comparable to those observed after primary implantations of oncologic prostheses.