Bone Defects in Revision Total Knee Arthroplasty and Management

Abstract

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.

Reconstruction for massive proximal tibial bone defects using patient-customized three-dimensional-printed metaphyseal cones in revision total knee arthroplasty

“…For mild proximal tibial defects (AORI type I and IIA), good clinical outcomes have been achieved by applying bone cement, metal screw, bone grafting, or metal augment [14]. On the other hand, for more severe bone defects, especially AORI type III, each traditional restoration technique has its own prominent shortcomings.…”

Falhas ósseas nas revisões de artroplastia total do joelho

“…Due to greater quantitative availability, the homologous graft is the most frequently used, although it presents a potential risk of disease transmission, fracture of the host bone during impaction and, also the possibility of graft absorption with loss of support capacity. 12,17,30,34,35 Increased risk for infection and concern about immunological reaction are also related to the homologous graft. 17 The surgical technique requires careful debridement of the bone defect with the use of a burr drill to remove the sclerotic bone from the periphery of the defect, thus forming a viable bed for osteointegration.…”

“…12,17,30,34,35 Increased risk for infection and concern about immunological reaction are also related to the homologous graft. 17 The surgical technique requires careful debridement of the bone defect with the use of a burr drill to remove the sclerotic bone from the periphery of the defect, thus forming a viable bed for osteointegration. The initial stability of components with the use of impacted bone graft is worrisome and is also influenced by the integrity of the cortex, the size of the defect and the type of implanted intramedullary nail.…”

“…Contained defects can be treated without major diffi-culties; however, for non-contained defects, a shaped plate or metal mesh should be used to avoid graft leakage and to increase the stability of the construction. 17,30,34 The intramedullary nail test must be properly positioned before the impaction of bone particles between 3 and 5 mm in size to provide greater initial stability. 17,30,34 The test implants are removed, and the final intramedullary nail must be inserted.…”

“…Structural bone graft from a tissue bank represents a costeffective option for the treatment of types 2 and 3 AORI bone defects, of varying shapes and sizes, in patients with greater physical demand and future possibility of a new rTKA. 17 The advantages of using the homologous graft consists of the capacity to restore bone stock and provides adequate initial support to the implants, allows the reinsertion of the epicondyles and avoids additional removal of the host bone. 17 However, in addition to the limited availability in our midst, this technique presents the risk of non-union, resorption and graft fracture, long surgical time, as well as the risk of disease transmission.…”