Use of Opteform® to Repair Failed Total Knee Prosthesis with Osteolysis

HARRY SCHMALTZ, M.D.
Scranton Orthopaedic Specialist
Clarks Summit, Pennsylvania

Presentation

A 58-year-old, 335 pound female with bilateral total knee arthroplasties was seen three weeks after a fall.  On examination, the right knee was found to be painful with laxity in both the A/P and M/L planes. Radiographs showed a large osteolytic lesion in the lateral femoral condyle (Figure 1). The patient elected to have revision right total knee arthroplasty.

Operation

The femoral and tibial components were removed. A large osteolytic defect was found in the lateral femoral condyle and a much smaller defect in the lateral tibial plateau. Defect sizes were 4cm deep by 3cm wide and 1cm deep by 1cm wide respectively.

Figure 1. Pre-operative: large osteolytic
defect in the lateral condyle.

Figure 2. Six weeks post-operative:
Opteform® (white arrows)
surrounding femoral head
allograft (black arrows).

A warmed 8cc disk of Opteform® was placed into the proximal portion of the femoral defect. A sagittally split, hemi-femoral head allograft was shaped and impacted into the defect on top of the Opteform®. A second warmed 8cc disk of Opteform® was used to fill in the remaining voids between the allograft and the host bone. The tibial defect was filled with the remainder of Opteform®. Femoral and tibial resections were made and Optetrak® total knee components were implanted to complete the revision procedure.

Post-operative Results

Radiographs taken at six weeks post-operatively (Figure 2) showed the femoral head allograft (black arrow) surrounded by Opteform® (white arrows) in the lateral femoral condyle. Three month radiographs showed consolidation of Opteform® in progress around the femoral head allograft and no migration of any component (Figure 3). Clinical examination demonstrated full extension and 110º flexion with no instability in either plane. Flexion at 1 year increased to 115º with continued stability and excellent component position. One year radiographs demonstrated graft incorporation with trabeculation traversing the Opteform® and good reconstitution of the lateral cortex (Figure 4).

Figure 3. Three months post-operative:
consolidation in progress and
stable components.

Figure 4. One year post-operative:
trabeculation across the Opteform
with good reconstitution of the
lateral cortex.