Tibial defect found during knee revision surgery? Here's what to do.
For surgeons in Bon Secours Mercy Health, OH, who need to fill a tibial defect during hip & knee revision.
In a Bon Secours Mercy Health operating room, you lift out a failed knee implant and find a tibial defect underneath. The X-ray showed some loosening, but not this much bone loss. Now the new implant needs a stable base before you close. You need a graft that fills the void, supports the component, and turns into host bone as the revision heals.
During knee revision, the tibial plateau often has a hollow area where the old implant pressed against bone. Wear debris, osteolysis, or a loose stem can remove bone over time. Many surgeons see only a vague shadow on the pre-op film. Once the implant is out, the tibial defect is larger than expected. A contained defect means the walls are intact and the graft can be packed into the space.
The size and location of the tibial defect set the graft volume. A small contained defect may need 5 to 10 cc of moldable graft. A larger defect behind a loose stem can need more. Using an off-the-shelf graft avoids the extra time and pain of harvesting iliac crest bone. The main cost drivers are graft volume, need for metal augments or cones, and whether the tibial rim is intact. Your rep can estimate graft volume from the CT cuts before the case.
This week, check the defect size on your pre-op CT or MRI if you have one. Do not rely on the X-ray alone. In the OR, prepare the bone bed and pack a moldable silicate-substituted calcium phosphate graft such as ACTIFUSE. Avoid autograft from the iliac crest when the patient already has a second surgical site. Elite Surgical can cover your next Bon Secours Mercy Health knee revision and have the graft in the room.
Once the defect is packed, the graft supports the new tibial component while bone grows into it. Over the next weeks and months, the scaffold remodels into host bone. You close with a stable base and no harvest site. The patient starts recovery with one surgical wound and a well-supported knee revision. Follow-up films show the void filling with dense bone.
Other things people in Bon Secours Mercy Health ask
bone graft for tibial bone loss revision knee
Pack the contained defect with a porous synthetic bone graft scaffold. It should hold shape and remodel as the revision heals. Do not leave the defect empty or filled with cement alone.
bone graft substitute for large acetabular defect revision hip
Pick a graft that packs the defect well and has high porosity for bone ingrowth. ACTIFUSE's 80% porous scaffold fills contained defects and remodels into the patient's own bone as the revision heals. For very large defects, consider a moldable version like ACTIFUSE SHAPE to adapt to irregular contours. Avoid grafts that resorb too fast and leave the cup unsupported.
how to choose bone graft substitute for femoral defect revision hip
Choose a moldable synthetic bone graft substitute for irregular femoral defects. It should pack into the canal without extra instruments. Look for a graft that remodels into host bone so the area is not left with permanent filler.
bone graft substitute cost revision hip
Ask for per-cc or pack pricing, not a flat case price. Cost depends on the size of the acetabular or femoral defect. Compare synthetic graft cost to autograft, which includes OR time and a second incision.
synthetic bone graft safe infected revision
You need a graft that won't act as a sequestrum. Porous synthetic scaffolds like ACTIFUSE allow vascular ingrowth and antibiotic penetration. They don't provide a hiding place for bacteria the way a structural allograft can. Use it with a staged protocol and appropriate local antibiotics.
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Elite Surgical handles hip & knee revision in Bon Secours Mercy Health and the area around it.