Bone defect classifications in revision total knee arthroplasty, their reliability and utility: a systematic review

Khan, Yasim; Arora, Sumit; Kashyap, Abhishek; Patralekh, Mohit Kumar; Maini, Lalit

doi:10.1007/s00402-022-04517-y

Cited by 8 publications

(6 citation statements)

References 83 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For lasting fixation there has to be adequate fixation in more than one zone. However, efforts to identify the best treatment are limited by the poor reliability of current defect classification systems [2,20]. Therefore, no correlation between the respective defect categories and the use of implants and augments has so far been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

“…In order to plan implants as well as methods of reconstruction and to achieve primary and long‐lasting stability, adequate preoperative assessment of the bone loss is key. To the best of our knowledge, no study has yet categorised tibial bone defects prior to rTKA in three dimensions [20]. Therefore, information on the frequencies and typical localisations of defects are missing.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

Brenneis,

Flevas,

Braun

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeThe primary purpose of the study was to use pre‐revision total knee arthroplasty (TKA) computer‐tomography (CT)‐images to analyse typical tibial bone defects and create a new schematic three‐dimensional (3D)‐classification system. The secondary purpose was to investigate the association between defect size and implant selection at the time of revision surgery.MethodsEighty‐four patients with preoperative CT‐scans underwent revision of a primary TKA. CT‐image segmentation with the 3D‐Slicer Software was performed retrospectively, and a new three‐dimensional classification system was used to grade tibial bone defects. The location of tibial bone defects was recorded for all cases. Volumetric 3D bone defect measurements were used to investigate the association between the bone defect volume, the indication for rTKA, and the use of modular revision components. The t‐test, the Mann–Whitney‐U test, and the Fisher's exact‐test were used for group comparisons, and the Kruskal–Wallis test was used for multiple group comparisons.ResultsThe most common anatomic regions for both contained and uncontained tibial bone defects were the anteromedial epiphysis (N = 50; mean epiphyseal‐defect: 5.9 cm³) and metaphysis (N = 15; mean metaphyseal‐defect: 9.6 cm³). A significant association was found between patients with preoperative metaphyseal defects (N = 22) and the use of tibial augments (N = 7) (p = 0.04). The use of cones/sleeves was associated with a significantly increased 3D‐CT volume of the preoperative metaphyseal bone defects (p = 0.04). Patients with osteoporosis had significantly larger volumetric defects in the metaphysis (p = 0.01).ConclusionOur results emphasise the importance of considering the three‐dimensional nature of tibial defects in rTKA. The findings suggest that an understanding of the volume of the defect size through CT imaging can predict the need for augments and cones/sleeves and, especially in patients with osteoporosis can help the surgeon identify larger metaphyseal defects and ensure optimal metaphyseal fixation through appropriate implant selection.Level of EvidenceLevel III, retrospective cohort study.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

Brenneis,

Flevas,

Braun

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

show abstract

“…Despite the efforts and the proposed modification, AORI classification remains a reliable system for femoral bone loss and substantial tibial bone loss [10,15].…”

Section: Bone Defects: Classification Systemmentioning

confidence: 99%

The Management of Bone Defects in Revision Knee Arthroplasty: The Role of Porous Metal Cones and 3D-Printed Cones

Marongiu,

Capone,

Verona

et al. 2023

Prosthesis

View full text Add to dashboard Cite

Worldwide, the number of revisions to total knee arthroplasty procedures is increasing. Revision surgery is a challenging procedure, required for the management of bone loss after removal of the first implant. Although further long-term follow-up studies are needed, the use of cones in revisions of total knee arthroplasty yields reliability in fixation and stability to restore joint lines, especially in challenging surgeries with poor bone stock. The introduction of 3D-printed cones in revision surgery seems to be advantageous for AORI type III bone defects, especially in reducing intraoperative complications and procedure times. The aim of this study is to review the currently available literature to analyse clinical outcomes, complications, and radiographical results with the use of metaphyseal tantalum cones and new 3D-printed cones for the management of bone defects in the revision of total knee arthroplasty.

show abstract

“…According to this system, a primary and long-term implant stability can be obtained when fixation in at least two of the epiphyseal, metaphyseal, and diaphyseal zones is achieved. However, developing a treatment algorithm for complex revision cases requires a reliable classification system for assessing bone loss preoperatively [ 12 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Anderson Orthopaedic Research Institute (AORI) classification is one of the most commonly used algorithms to describe bone loss in rTKA [ 7 , 12 ]. The AORI classification was published in 1999 with the intention to classify tibial and femoral bone loss pre- and intraoperatively to guide surgical treatment [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Tibial bone defect prediction based on preoperative artefact‐reduced CT imaging is superior to standard radiograph assessment

Brenneis,

Flevas,

Bornes

et al. 2023

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

Purpose The purpose of this study was to evaluate the accuracy of preoperative CT-based Anderson Orthopaedic Research Institute (AORI)-grading and to correlate Computed tomography (CT)-based volumetric defect measurements with intraoperative AORI findings. Methods 99 patients undergoing revision total knee arthroplasty (rTKA) with preoperative CT-images were identified in an institutional revision registry. CT-image segmentation with 3D-Slicer Software was used to create 3D tibial bone defects which were then graded according to the AORI-classification. The AORI classification categorizes tibial defects into three types: Type I has healthy cortical and cancellous bone near the joint line, Type II involves metaphyseal bone loss affecting one or both condyles, and Type III indicates deficient metaphyseal bone with distal defects and potential damage to the patellar tendon and collateral ligament attachments. These 3D-CT gradings were compared to preoperative X-ray and intraoperative AORI grading. The Friedman test was used to investigate differences between AORI values of each measurement method. Volumetric 3D-bone defect measurements were used to investigate the relationship between AORI classification and volumetric defect size in the three anatomic zones of the tibia. Results Substantial agreements between preoperative 3D-CT AORI and intraoperative AORI (kappa = 0.663; P < 0.01) and fair agreements between preoperative X-ray AORI and intraoperative AORI grading (kappa = 0.304; P < 0.01) were found. Moderate correlations between volume of remaining bone and intraoperative AORI grading were found in epiphysis (rS = – 0.529; P < 0.001), metaphysis (rS = – 0.557; P < 0.001) and diaphysis (rS = – 0.421; P < 0.001). Small volumetric differences between AORI I vs. AORI II defects and relatively large differences between AORI II and AORI III defects in each zone were detected. Conclusion Tibial bone defect prediction based on preoperative 3D-CT segmentation showed a substantial agreement with intraoperative findings and is superior to standard radiograph assessment. The relatively small difference in defect volume between AORI I, IIa and IIb suggests that updated CT-based classifications might hold benefits for the planning of rTKA. Level of evidence Retrospective Cohort Study; III

show abstract

Bone defect classifications in revision total knee arthroplasty, their reliability and utility: a systematic review

Cited by 8 publications

References 83 publications

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

The Management of Bone Defects in Revision Knee Arthroplasty: The Role of Porous Metal Cones and 3D-Printed Cones

Tibial bone defect prediction based on preoperative artefact‐reduced CT imaging is superior to standard radiograph assessment

Contact Info

Product

Resources

About