Cementless fixation in revision total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Regenerative Medicine

Background:

• Revision total knee arthroplasty (TKA) presents challenges, particularly in cases of severe bone loss.
• Traditional revision TKA often involves significant bone resection and soft tissue disruption, potentially compromising long-term outcomes.

Purpose of the Study:

• To evaluate a surgical approach for revision TKA focused on bone and soft tissue preservation.
• To assess the efficacy and durability of cementless fixation with morselized allografting for severe bone defects.

Main Methods:

• A prospective study involving 105 patients (110 knees) with severe bone loss undergoing revision TKA.
• Utilized minimal bone resection, minimal soft-tissue stripping, cementless fixation with titanium stems, and morselized allografting.
• Follow-up ranged from 60 to 127 months, assessing ligamentous stability, pain scores, and radiographic evidence of bone healing.

Main Results:

• Consistent ligamentous stability and pain relief were observed throughout the follow-up period.
• Radiographic evidence of bone healing in defects and increased radiodensity were noted postoperatively.
• Low failure rates (one loosening, one infection) in the cohort.

Conclusions:

• A surgical approach preserving bone and soft tissue is effective for revision TKA with severe bone loss.
• Cementless fixation and allografting provide a durable construct for complex knee reconstructions.
• This technique establishes a reliable method for managing challenging revision TKA cases.