Revision Total Knee Arthroplasty (original) (raw)
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Bone reconstruction in revision total knee arthroplasty
Seminars in Arthroplasty, 2003
There are approximately 20,000-revision total knee arthroplasties (TKA) performed in North America annually. With a growing number of TKAs being performed and the trend toward a longer life expectancy, failure of the primary TKA is inevitable, thus, revision TKAs are going to be performed at an increasing rate for years to come. A major issue in revision TKA is the degree of bone loss that has occurred. In this article the authors discuss the different classification schemes regarding bone loss and their impact on subsequent treatment modalities. A discussion on assessment of bone loss and the multiple techniques, along with indications for each, that can be employed intraoperatively to account for the bone loss will enable the surgeon to undergo the challenge of bone reconstruction in a stepwise fashion. The article provides advantages and disadvantages to each technique as well as a review of the current literature. Bone deficiency from component removal, osteolysis, or gap balancing can prove to be a significant problem in revision TKA. With careful planning, appropriate judgment, and good surgical technique, good results can be achieved.
Technical Considerations in Total Knee Arthroplasty
Clinical Orthopaedics and Related Research, 1986
Results with total knee arthroplasty as published in this issue show few mechanical failures in knees correctly aligned. If the principles of technique are respected, the narrow Limits for margin of error can be met. To provide optimal results, the following measures are recommended. The tibia should be cut no more than 5 mm from the medial subchondral bone, if the posterior cruciate ligament is sacrificed, and between 5 mm and 8 mm, if the posterior cruciate is saved. Fill a defect as necessary with bone graft. The tibia should be cut 90" to its axis in the medial-lateral plane and with 5" posterior tilt. Maintain the anterior-posterior height of the femur to ensure flexion stability. Use the distal femur as the "adjustment cut" even if the F i t Line is elevated. If the posterior cruciate ligament tension is tight, lengthen the ligament or convert to a sacrificing design. Deformity should be corrected with soft tissue release and not angular bone cuts. The patella cut should be performed so that the result is a symmetrical patella that is not increased from its anatomic height. If these principles are followed, the instrumentation use and order of osteotomy of the distal femur or tibia do not matter. CONTROVERSIES IN TECHNIQUE Several significant variables affecting prosthetic loosening come under the direct control of the surgeon both preoperation and at the
JPMA. The Journal of the Pakistan Medical Association, 2006
Total knee arthroplasty (TKA) is a satisfactory procedure regarding functional outcome and pain relief. The ever increasing number of total knee arthroplasties and expanding indications have led to a high number of revisions. The principles of revision arthroplasty are to understand the cause of failure, adequate surgical exposure, restoration of limb alignment, achieving appropriate soft tissue balance, correct implant alignment, restoration of joint line and a good range of motion. The literature on revision TKA is diverse and is not conclusive in many aspects. The results of revision surgery are not as good as the primary TKA with main causes being increased polyethylene wear, aseptic loosening, malalignment of components, instability, extensor mechanism problems, infection and stiffness. Revision knee Arthroplasty is not a repeat primary Arthroplasty but it is a technically and economically demanding procedure and its successful performance requires thorough preoperative plannin...
Principles of revision total knee arthroplasty
Seminars in Arthroplasty, 2003
Revision total knee arthroplasty (TKA) is considered by some to be the most difficult procedure in the field of orthopaedic surgery. Good results can be consistently obtained if a meticulous and methodic approach is taken by the provider. Keeping the goals of treatment in mind ...
The Journal of Bone and Joint Surgery
ailure of primary total knee arthroplasty within five years after the operation most frequently occurs because of deep infection (38%), instability (27%), failure of bone ingrowth into a cementless implant (13%), patellar problems (8%), wear (7%), loosening (3%), or miscellaneous problems (4%) 1 . In contrast, in a series of 427 revision total knee arthroplasties, failure of fixation was the most frequent problem, followed by abnormal alignment, component malposition, osseous fracture, and patellar problems 2 . The results of revision total knee arthroplasty are difficult to assess because they are influenced by many factors: the etiology of failure, the extent of bone loss, the quality of the soft tissues, the technique of reconstruction, the adequacy of rehabilitation, patient compliance, the duration of follow-up, and the mode of assessment. Contemporary modular designs have provided good short-term results. A combined review of 161 revisions that had been performed with a modular constrained condylar knee or posterior stabilized design revealed an 80% rate of good or excellent results after an average duration of follow-up of 3.5 years, with a 33% prevalence of radiolucent lines and a 10% rate of complications 3 . The durability of the results will depend in part on the integrity of the locking mechanisms of the modular components, the quality of the polyethylene, and the load transfer conferred by modular stems and augments to the implants. Long-term studies will be necessary to determine if these modular designs are more durable than nonmodular prostheses.
Managing bone loss in revision total knee arthroplasty
Annals of Joint, 2016
While the management of bone loss in revision total knee arthroplasty (TKA) has improved over the past decade, it is still challenging for orthopedic surgeons. Small or contained defects may be treated with bone graft, cement augmentation, cement augmentation with screw fixation, or modular augments. It is more difficult to manage large or uncontained defects. Historically, these larger defects were treated with allograft, but within the last decade, tantalum cones and titanium sleeves have been used to obtain better implant fixation where bone deficiency is an issue. These meta-diaphyseal implants can reduce mechanical stress at the level of the joint line, and may reduce the need for fully constrained implants.
Bone Allograft in Revision Total Knee Replacement
Cell and Tissue Banking, 2000
Revision total knee replacement (TKR) is often associated with the necessity to reconstruct a certain amount of bone loss. In a retrospective study we reviewed the records of 137 patients who had undergone revision TKR in our department between 1990 and 1996, due to loosening or inflection. Bone allografts were used in 91 patients (67%) to accomplish stable, new prostheses.
TOTAL KNEE SURGERY: OUR EXPERIENCE
Introduction: Revision knee arthroplasty is not a routine procedure and almost always it is a technically demanding operation. The paradigm in revision total knee arthroplasty is to achieve correct alignment of the components, maintenance of the joint space and ligament balance by providing a stable bone – implant fusion. Metaphyseal bone loss is a crucial problem in revision total knee arthroplasty. The bone loss is due to primary arthroplasty technical errors and design, or problematic removal of the implants. Aim: The aim of this article is to present our experience on total knee revision surgery using tantalum metal cones as a structural bone graft substitute in total arthroplasty failure with gross metaphyseal bone loss categorized by the AORI classification, performed by a specific surgical technique and evaluated by the Knee Society Score (KSS). Material and methods: From 2013 to 2016 at the University Clinic for Orthopedic Surgery in Skopje 21 patient has been treated with revision total knee arthroplasty. Twelve patients had type 1/type 2 bone defects according to AORI, and nine had type 3 bone defect. We used trabecular metal bone graft in type 3 bone defects. A special emphasis is placed on preoperative planning according to the classification system for ligament and soft tissue damage as well as the AORI classification in order to determine the quantity, location and extent of the bone loss. In our series in patients with type 3 deformities, trabecular metal augments were used. This material resembles the human trabecular bone by its cellular structure and elastic characteristics. Results: Preoperatively, all the patients had Knee Society Score below 60, most of them were housebound, experiencing great pain and disability. After six months 95% were rated excellent, and on one year follow up, 89% were rated good or excellent (KSS score above 82, mean score 81.5), 1 patient was marked as poor with a complication – dislocation of the prosthesis. In the follow up period there was no infection. Conclusion: Our results of revision knee arthroplasty by using the trabecular metal augments with at least a year of follow up are excellent according to the KSS compared to the other studies. The disadvantages of the study are mentioned and the need for further investigation is stressed.
Revision Total Knee Arthroplasty Causes of failure, bone loss management and outcomes\
Revista de Chimie, 2018
The objectives of the current study were to identify the causes leading to revision knee arthroplasty, analyse implant choices and assess the short-term outcome. The current study is a retrospective on including a group of 33 patients operated between Jan 2013-Dec 2016 in a single institution. Data was collected from the Romanian National Arthroplasty Register. The cause for revision surgery was noted, as well as the type of implant used during the surgical procedure. The bony defect was classified according to the Anderson Orthopaedic Research Institute (AORI) Classification and the reconstruction method was analysed. Functional outcome was assessed using Oxford Knee Score preoperatively and at one year follow-up. Infection was the cause of failure in 18 cases, aseptic loosening in 11 cases, malposition of implants in 2 cases, instability in 1 case and periprosthetic fracture in 1 case. Revision implants were chosen based on joint stability and degree bone loss. The preferred impla...
Reconstruction of massive bone defects with allograft in revision total knee arthroplasty
The Journal of bone and joint surgery. American volume, 1997
Allograft bone was used to reconstruct a defect in the proximal aspect of the tibia or the distal aspect of the femur, or both, in thirty knees of twenty-eight patients who had a revision total knee arthroplasty. The average age of the patients at the time of the index procedure was 65.8 years (range, twenty-four to eighty-nine years). At an average of fifty months (range, twenty-four to 132 months; median, thirty-six months) postoperatively, the score for twenty-three knees (twenty-one patients) had increased by at least 20 points, and these knees did not need additional operative treatment. Thus, the rate of success was 77 per cent. The procedure was considered a failure for the remaining seven knees because of infection (three), loosening of the tibial component (two), fracture of the graft (one), and non-union at the allograft-host junction (one). Properly applied allograft can be used to reconstruct massive bone defects, provide stability and support for implants, and restore b...