scholarly journals The Use of Structural Allograft in Primary and Revision Knee Arthroplasty with Bone Loss

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Raul A. Kuchinad ◽  
Shawn Garbedian ◽  
Benedict A. Rogers ◽  
David Backstein ◽  
Oleg Safir ◽  
...  
Keyword(s):  
Bone Loss ◽  
Knee Arthroplasty ◽  
Older Patients ◽  
Bone Stock ◽  
Challenging Problem ◽  
Revision Knee Arthroplasty ◽  
Simple Addition ◽  
Tumour Prosthesis ◽  
Total Knee ◽  
Segmental Bone

Bone loss around the knee in the setting of total knee arthroplasty remains a difficult and challenging problem for orthopaedic surgeons. There are a number of options for dealing with smaller and contained bone loss; however, massive segmental bone loss has fewer options. Small, contained defects can be treated with cement, morselized autograft/allograft or metal augments. Segmental bone loss cannot be dealt with through simple addition of cement, morselized autograft/allograft, or metal augments. For younger or higher demand patients, the use of allograft is a good option as it provides a durable construct with high rates of union while restoring bone stock for future revisions. Older patients, or those who are low demand, may be better candidates for a tumour prosthesis, which provides immediate ability to weight bear and mobilize.

Distal Femoral Replacement for Periprosthetic Fractures around Total Knee Arthroplasty: When and How?

2019 ◽  
Vol 32 (05) ◽  
pp. 388-391 ◽  
Author(s):  
Saad Khan ◽  
Andrew Schmidt
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Older Patients ◽  
Open Reduction Internal Fixation ◽  
Periprosthetic Fractures ◽  
Bone Stock ◽  
Careful Evaluation ◽  
Total Knee ◽  
Distal Femoral Replacement

AbstractPeriprosthetic fractures around total knee arthroplasty have become more common with the increasing incidence of total knee arthroplasty. These fractures are challenging to treat, especially in older patients with poor bone stock. Although open reduction internal fixation remains the most common treatment, revision with distal femoral replacement has become popular in recent years. Careful evaluation and planning are required to have successful outcomes. We present a review of distal femoral replacement in periprosthetic fractures around the total knee arthroplasty, along with surgical technique, and pearls and pitfalls.

THE PATHOGENESIS OF BONE LOSS FOLLOWING TOTAL KNEE ARTHROPLASTY

1998 ◽  
Vol 29 (2) ◽  
pp. 187-197 ◽  
Author(s):  
Peter L. Lewis ◽  
Nigel T. Brewster ◽  
Stephen E. Graves
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Knee Arthroplasty ◽  
Total Knee

A different fixation of the femoral component in total knee arthroplasty may lead to preservation of femoral bone stock

2003 ◽  
Vol 217 (5) ◽  
pp. 325-332 ◽  
Author(s):  
M Barink ◽  
N Verdonschot ◽  
M de Waal Malefijt
Keyword(s):  
Femoral Component ◽  
Knee Arthroplasty ◽  
Bone Remodelling ◽  
Significant Loss ◽  
Bone Stock ◽  
Femoral Bone ◽  
Secondary Effects ◽  
Total Knee ◽  
The Stability

Good femoral bone stock is important for the stability of the femoral component in revision knee arthroplasty. However, the primary total knee replacement (TKR) may cause significant loss of bone stock in the distal anterior femur. Earlier stress-induced bone remodelling simulations have suggested that a completely debonded component may save bone stock in the distal anterior region. However, these simulations did not consider the fixation of a debonded implant and possible secondary effects of micromotions and osteolysis at the interface. The current study tries to combine the preservation of bone stock with adequate component fixation. Different bone remodelling simulations were performed around femoral knee components with different sizes of bonding area and different friction characteristics of the debonded area. The fixation of the femoral component with different bonding characteristics is quantified with calculated implant-bone interface stresses. The results show that a bonded femoral component with a debonded inner side of the anterior flange may significantly reduce bone resorption in the endangered distal anterior femur, without jeopardizing the fixation of the femoral implant. This effect may be obtained in vivo by using a femoral component with a highly polished inner side of the anterior flange.

scholarly journals The role of rotating hinge implants in revision total knee arthroplasty

2019 ◽  
Vol 4 (6) ◽  
pp. 269-278 ◽  
Author(s):  
Gilles Pasquier ◽  
Matthieu Ehlinger ◽  
Didier Mainard
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Complication Rates ◽  
Poor General Health ◽  
Joint Reconstruction ◽  
Bone Fixation ◽  
Rotating Hinge ◽  
Total Knee ◽  
Segmental Bone

Hinged implants are the most constrained knee replacement prostheses. They are very useful in complex cases of total knee arthroplasty (TKA) revision. Hinged implants have evolved with rotating bearings and modularity that allows local joint reconstruction or segmental bone replacement. They are required when significant instability persists in cases with inadequate collateral ligaments and significant flexion laxity. They are now used when a large bone defect is reconstructed, or when bone fixation of the implant is questionable especially in the metaphyseal zone. The use of hinged implants in TKA revision is associated with high complication rates. Published outcomes differ based on the patients’ aetiology. The outcomes of rotating-hinged implants used in septic revisions or salvage situations are poorer than other types of revision and have a higher complication rate. The poor general health of these patients is often a limitation. Despite these relatively poor results, hinged implants continue to have a place in revision surgery to solve major instability or to obtain stable bone fixation of an implant when the metaphysis is filled with bone grafts or porous devices.Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180070

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