Management of Bone Loss in Revision Total Knee Arthroplasty

Huff, Thomas W.; Sculco, Thomas P.

doi:10.1016/j.arth.2007.05.022

Cited by 58 publications

(40 citation statements)

References 16 publications

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“…In particular, when load bearing situations are targeted and the quality of the bone is not optimal for an autograft the surgeon may be tempted to use an artificial scaffold to fill the bone defect. This situation often arises during revision of total knee replacement, where significant bone loss can be found either under the tibial tray or in the femoral part of the knee implant [2]. Unfortunately, in this case the use of calcium phosphate cement is not suitable for filling the bone defects, as this material is too brittle to sustain the shocks that will inevitably arise during normal daily activity [3].…”

Section: Introductionmentioning

confidence: 99%

Augmentation of bone defect healing using a new biocomposite scaffold: An in vivo study in sheep

et al. 2010

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a b s t r a c tPrevious studies support resorbable biocomposites made of poly(L-lactic acid) (PLA) and b-tricalcium phosphate (TCP) produced by supercritical gas foaming as a suitable scaffold for tissue engineering. The present study was undertaken to demonstrate the biocompatibility and osteoconductive properties of such a scaffold in a large animal cancellous bone model. The biocomposite (PLA/TCP) was compared with a currently used b-TCP bone substitute (ChronOS™, Dr. Robert Mathys Foundation), representing a positive control, and empty defects, representing a negative control. Ten defects were created in sheep cancellous bone, three in the distal femur and two in the proximal tibia of each hind limb, with diameters of 5 mm and depths of 15 mm. New bone in-growth (osteoconductivity) and biocompatibility were evaluated using microcomputed tomography and histology at 2, 4 and 12 months after surgery. The in vivo study was validated by the positive control (good bone formation with ChronOS™) and the negative control (no healing with the empty defect). A major finding of this study was incorporation of the biocomposite in bone after 12 months. Bone in-growth was observed in the biocomposite scaffold, including its central part. Despite initial fibrous tissue formation observed at 2 and 4 months, but not at 12 months, this initial fibrous tissue does not preclude long-term application of the biocomposite, as demonstrated by its osteointegration after 12 months, as well as the absence of chronic or long-term inflammation at this time point.

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Section: Introductionmentioning

confidence: 99%

Augmentation of bone defect healing using a new biocomposite scaffold: An in vivo study in sheep

et al. 2010

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“…The indication was revision surgery in 21 patients and complex primary surgery in five. In revision surgery, large portions of distal femur or proximal tibia are missing, including ligamentous deficiency (segmental bone loss type according to Huff and Sculco's simplified classification [9]). Three patients showed medial ligamentous deficiency, another five presented lateral ligamentous deficiency, and both ligaments were missing in the rest.…”

Section: Methodsmentioning

confidence: 99%

“…This happens in the segmental type [9], combined epiphyseal and cavitary patterns, and types of bone destruction in which large portions of distal femur or proximal tibia are missing, which may include collateral ligament attachment.…”

Section: Introductionmentioning

confidence: 99%

Hinged Total Knee Arthroplasty in the Presence of Ligamentous Deficiency

Hernández-Vaquero

Sandoval-García

2010

Clinical Orthopaedics &Amp; Related Research

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Background Rotating-hinge total knee prostheses may be used for the treatment of global instability about the knee. The designs of previous generations were associated with suboptimal outcomes. Questions/purposes We evaluated the clinical and radiographic outcomes of salvage knee reconstructions using modern-generation, modular, kinematic rotating-hinge total knee prostheses. Methods We retrospectively reviewed 26 rotating-hinge arthroplasty devices to examine whether acceptable results were obtainable using a single arthroplasty design. The average age of the patients was 77 years (SD, 9 years); the minimum followup was 24 months (mean, 46 months; range, 24-107 months). The indication was revision surgery in 21 patients and complex primary surgery in five.

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“…During the removal of the primary prosthesis, a part of the bone that was in contact with the prosthesis is usually damaged (Huff and Sculco 2007). For these revision prostheses, initial stability is a key issue because of the loss of bone support.…”

Section: Introductionmentioning

confidence: 99%

“…Allografts and xenografts allow ingrowth of bone and restoring bone stock, are easy to shape, and are relatively cheap, but there is always a risk of viral disease transfer from the donor to the host (Boyce et al 1999). Metallic augments, on the other hand, provide excellent mechanical properties, but they do not biologically restore the bone stock and they usually require additional bone removal, although minimal, to make the pattern of bone loss encountered match exactly the configuration of the augment (Huff andSculco 2007a, 2007b;Mabry and Hanssen 2007). Therefore, there is a need for a bone substitute that overcomes these limitations, and tissue engineered bone substitutes have been proposed (Yaszemski et al 1996).…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

Terrier

Sedighi-Gilani

Ghias

et al. 2009

Computer Methods in Biomechanics and Biomedical Engineering

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Tibial bone defect is a critical problem for revision knee arthroplasty. Instead of using metallic spacer or cement, biodegradable scaffolds could be an alternative solution. A numerical model of a revision knee arthroplasty was thus developed to estimate the mechanical resistance of the scaffold in this demanding situation. The tibia, scaffold, and prosthesis were represented by simplified parameterised geometries. The maximal gait cycle force was applied asymmetrically to simulate a critical loading. Several parameters were analysed: 1) inter-individual variability, 2) cortical bone stiffness, 3) cortical bone thickness, 4) prosthesis fixation quality, and 5) scaffold thickness. The calculated scaffold strain was compared to its experimental ultimate strain. Among the tested parameters, failure was only predicted with scaffold thickness below 5 mm. This study suggests that biodegradable bone scaffolds could be used to fill bone defects in revision knee arthroplasty, but scaffold size seems to be the limiting factor.

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Management of Bone Loss in Revision Total Knee Arthroplasty

Cited by 58 publications

References 16 publications

Augmentation of bone defect healing using a new biocomposite scaffold: An in vivo study in sheep

Augmentation of bone defect healing using a new biocomposite scaffold: An in vivo study in sheep

Hinged Total Knee Arthroplasty in the Presence of Ligamentous Deficiency

Biomechanical evaluation of porous biodegradable scaffolds for revision knee arthroplasty

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