Allograft-prosthesis composite (APC) can restore capsular and ligamentous tissues of the knee sacrificed in a tumor extirpation. We asked if performing APC would restore knee stability and allow the use of nonconstrained arthroplasty while preventing aseptic loosening. We retrospectively compared 50 knee APCs performed with non-constrained revision knee prosthesis (Group 1) with 36 matched APCs performed with a constrained prosthesis (Group 2). In Group 1, the survival rate was 69% at five and 62% at ten years. Sixteen reconstructions were removed due to complications: eight deep infections, three fractures, two instabilities, one aseptic loosening, one local recurrence, and one nonunion. In Group 2, the survival rate was 80% at five and 53% at ten years. Nine reconstructions were removed: 3 due to deep infections, 3 to fractures, and 3 to aseptic loosening. In both groups, we observed more allograft fractures when the prosthetic stem does not bypass the host-donor osteotomy ( ). Both groups had mainly good or excellent MSTS functional results. Survival rate and functional scores and aseptic loosening were similar in both groups. A rotating-hinge APC is recommended when host-donor soft tissue reconstruction fails to restore knee instability. The use of a short prosthetic stem has a statistical relationship with APC fractures. 1. Introduction The potential benefits of allograft-prosthesis composite (APC) include restoration of bone stock, possible reattachment of tendons to the graft, and improved longevity through load-sharing properties of the allograft [1–3]. The ongoing challenge is choosing the most appropriate implant for this type of reconstruction. Constrained implants provide the needed stability for arthroplasty in the presence of a deficient soft-tissue envelope. However there is a requisite transmission of grater forces to the fixation interfaces, which may lead to premature aseptic loosening [4, 5]. A posterior-stabilized or semiconstrained revision knee arthroplasty is usually contraindicated in knees with severe metaphyseal bone loss and instability [3, 6, 7]. Nevertheless, when the less constrained device is combined with a massive allograft stabilizing soft tissue elements may be sufficient [8–10]. If stability is not maintained, problems of edge loading, aseptic loosening, and fracture may ensue. Each type of articulation has theoretic advantages and disadvantages. The type of arthroplasty device to be used is determined by how much stability is lost from the tumor resection [8–10]. If a significant amount of the collateral ligaments is
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