Zonal fixation in revision total knee arthroplasty

Morgan–Jones, Rhidian; Oussedik, Sam; Graichen, Heiko; Haddad, Fares S.

doi:10.1302/0301-620x.97b2.34144

Cited by 247 publications

(115 citation statements)

References 28 publications

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“…При данном варианте реконструкции сложности в корректном пространственном позиционировании втулки и, соответственно, эндопротеза возникают, если диафизы бедренной или большеберцовой костей деформированы [10]. Поэтому у ряда пациентов установить удлиняющую ножку становится невозможным, и если это сочетается с дефицитом костной массы эпифиза, то компрометируется принцип достижения фиксации ревизионного имплантата как минимум в двух зонах [11]. Вместе с тем результаты использования металлических втулок с напылением (средний срок наблюдения 3,6±1,4 лет) и конусов (средний срок наблюдения 4,5±1,6 лет) показывают хорошую выживаемость имплантатов в раннем и среднесрочном периодах (97,3 и 97,8% соответственно) [12].…”

Section: Discussionunclassified

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Cherny

Коваленко

Билык

et al. 2019

Traumatology and Orthopedics of Russia

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The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

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Section: Discussionunclassified

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Cherny

Коваленко

Билык

et al. 2019

Traumatology and Orthopedics of Russia

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“…In this scenario, obtaining a stable fixation of the revision implant is mandatory. Morgan-Jones et al [52] recently defined the "zonal fixation" concept. The femur and tibia can be divided into three zones: the joint surface or epiphysis, the metaphysis, and the diaphysis.…”

Section: Treatment Of Bone Deficiency In Revision Total Knee Arthroplmentioning

confidence: 99%

Treatment of Bone Losses in Revision Total Hip and Knee Arthroplasty Using Trabecular Metal: Current Literature

Cottino

Rosso

Dettoni

et al. 2016

Journal of Nanomaterials

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Revision Total Knee or Hip Arthroplasty is challenging procedures for surgeons usually characterized by bone loss. There are different options available to treat those bone losses. However, there is still a concern on the stability of bone-implant interface, which is mandatory to achieve good long-term results in prosthetic implants. Recently, porous tantalum has been introduced, with the aim of improving the bone-implant interface fixation and implant primary stability. Different solutions for the treatment of bone defects in both revision Total Knee and Hip Arthroplasty have been proposed. In revision Total Hip Arthroplasty (THA) tantalum shells can be used to treat Paprosky type III defects also, because of their mechanical properties. Similarly, trabecular metal has been proposed in revision Total Knee Arthroplasty (TKA), being considered a viable option to treat severe type 2 or 3 defects. The aim of this paper is to review the mechanical properties and characteristics of tantalum. Furthermore, we will discuss its role in treating bone defects in both revision THA and TKA, as well as the outcome reported in literature.

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“…Traditionally such defects are managed with stemmed implants that are either fully cemented or cemented in the epiphyseal/metaphyseal area. It was suggested that appropriate implant stability can be achieved if solid fixation is attained using at least two of three defined anatomical zones of fixation (epiphysis or joint surface, metaphysis, and diaphysis) . This suggests that if adequate epiphyseal and metaphyseal implant fixation can be achieved, revision of AORI IIB defects could be done appropriately with stemless implants.…”

mentioning

confidence: 99%

“…Metaphyseal sleeves, have been introduced to compensate for severe osseous defects and provide better zonal fixation in the metaphysis . Several clinical studies with short term follow up have suggested that using the metaphyseal sleeves without stems, can provide adequate initial implant stability when reconstructing tibiae with AORI type II and III defects .…”

mentioning

confidence: 99%

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

Awadalla

Al-Dirini

O’Rourke

et al. 2019

Journal Orthopaedic Research

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Metaphyseal augments, such as sleeves, have been introduced to augment the fixation of revision total knee replacement (rTKR) components, and can be used with or without a stem. The effect of sleeve size in combination with stems on the primary stability and load transfer of a rTKR implant in AORI type IIB defects where the defect involves both condyles are poorly understood. The aim of this study was to examine the primary stability of revision tibial tray augmented with a sleeve in an AORI type IIB defect which involves both condyles with loss of cortical and cancellous bone. Finite element models were generated from computed tomography (CT) scans of nine individuals. All the bones used in the study had an AORI type IIB defect. The cohort included eight females (mean weight: 64 kg, height: 1.6 m). Material properties were sampled from CT data and assigned to the FE model. Joint contact forces for level gait, stair descent, and squat were applied. Stemless sleeved implants under various loading conditions were shown to have adequate primary stability in all AORI type IIB defects investigated. Adding a stem only marginally improved the primary stability of the implant but reduced the strain in the metaphysis compared to stemless implants. Once good initial mechanical stability was established with a sleeve, there was no benefit, in terms of primary stability or bone strains, from increasing sleeve size. This study suggests that metaphyseal sleeves, without a stem, can provide the required primary stability required by a rTKR tibial implant, to reconstruct an AORI type IIB defect. ß

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Zonal fixation in revision total knee arthroplasty

Cited by 247 publications

References 28 publications

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Treatment of Bone Losses in Revision Total Hip and Knee Arthroplasty Using Trabecular Metal: Current Literature

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

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