This article reviews the recent updates in revision of total knee arthroplasty (RTKA). We reviewed the recent articles on RTKA in databases including PubMed, Google Scholar, and SCOPUS. Total knee arthroplasty (TKA) involves the replacement of all three compartments of the knee in surgery of the knee joint to restore capacity and function. TKA is one of the most common and reliable surgical treatment options for the treatment of knee diseases. However, some patients require revision of TKA (RTKA) after primary TKA for various reasons, including mechanical wear, implant loosening or breakage, malalignment, infection, instability, periprosthetic fracture, and persistent stiffness. Unfortunately, the overall outcome of RTKA is not as satisfactory as for primary TKA due to the uncertainty regarding the actual success rate and the risk factors for failure. Cementation, modular metal augmentation, bone grafting, autologous bone grafting, allogenic bone grafting, impactation bone grafting, structural bone allografting, metaphyseal fixation, using porous titanium coated press fit metaphyseal sleeves and porous tantalum structural cones, and megaprostheses or customized prostheses are the currently available management options for RTKA. However, most of the management systems possess specific complications. Novel approaches should be developed to improve functional capacity, implant survival rates, and quality of life in a cost‐efficient manner.

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BackgroundVenous thromboembolism (VTE) is considered a potentially serious complication of knee arthroscopy and leads to conditions such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Low-molecular-weight heparin (LMWH) is widely employed in knee arthroscopy to reduce perioperative thromboembolic complications. However, the efficacy and safety of LMWH in knee arthroscopy remains unclear.MethodsSeven randomized controlled clinical trials on LMWH in knee arthroscopy were identified and included in this meta-analysis. The main outcomes of the effectiveness (prevention of DVT and PE) and complications (death, major bleeding, and minor bleeding) of LMWH in knee arthroscopic surgery were assessed using Review Manager 5.3 software.ResultsThe meta-analysis indicated that LMWH prophylaxis comprised 79% of asymptomatic DVT. No association was found in symptomatic VTE (RR: 0.90; 95% confidence interval [CI]: 0.39–2.08; P = 0.80), symptomatic DVT (RR: 0.79; 95% CI: 0.28–2.23; P = 0.66), symptomatic PE (RR: 1.36; 95% CI: 0.37–4.97; P = 0.64) and major bleeding (RR: 0.70; 95% CI: 0.12–3.95; P = 0.68) risk during LMWH prophylaxis were identified. Death was not reported in these studies. Moreover, there was a lower incidence of minor bleeding (RR: 0.64; 95% CI: 0.49 to 0.83; P = 0.001) in the control group than in the LMWH group.ConclusionCompared with the control group, the group treated with LMWH after knee arthroscopy was no association in reducing the symptomatic VTE rate, symptomatic DVT rate or symptomatic PE rate. The symptomatic VTE rate was 0.5% (11/2,166) in the LMWH group versus 0.6% (10/1,713) in the control group. Although the limitations of this meta-analysis cannot be ignored, the results of our study show that LMWH after knee arthroscopy is ineffective. We recommend that LMWH should not be routinely provided for knee arthroscopy.Trial registrationClinicalTrials.gov NCT03164746

BackgroundThe conventional method of core decompression combined with porous bioceramics rod is usually performed under C-arm fluoroscopy for the treatment of early osteonecrosis of the femoral head (ONFH). This study was to evaluate the clinical value and efficacy of three-dimensional (3D) printing guide plate in the process of core decompression plus porous bioceramics rod for the treatment of early ONFH.MethodsForty patients were enrolled, including 20 patients undergoing the surgery with 3D printing guide plate in the experiment group and 20 controls with C-arm fluoroscopy. The following parameters such as surgery time, blood loss, fluoroscopy times, and the accuracy of core decompression for necrosis area, function outcome according to Harris Hip Score (HHS), and any possible complications were recorded and compared between the two groups. All the patients were followed up at 6, 12, and 18 months postoperatively.ResultsThe surgery time, fluoroscopy time, and intraoperative blood loss in the experiment group was significantly less (P < 0.05) than those in the control group. There was no statistical significance in the accuracy of core decompression and porous bioceramics rod placement between the two groups (P > 0.05). All patients were followed up for 18 months. There was a significant difference between the preoperative and final follow-up HSS scores in both groups (P < 0.05). In addition, there was also a significant difference between the groups in the last follow-up HSS scores (P < 0.05).ConclusionsCompared with the traditional method, 3D printing guide plate could shorten the surgery time and fluoroscopy times and decrease intraoperative blood loss. It seems to be an effective method in the combined core decompression with porous bioceramics rod placement for early ONFH.

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