Bone loss management in total knee revision surgery

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Reconstructive Surgery

Background:

• Bone stock deficiency is a significant challenge in total knee replacement (TKR) revision surgery.
• Causes include stress shielding, osteolysis, aseptic/septic loosening, and iatrogenic bone loss during implant removal.
• Preserving bone stock during revision is critical for successful outcomes.

Purpose of the Study:

• To review challenges and strategies for bone stock reconstruction in TKR.
• To discuss factors influencing the choice of surgical technique and implant for bone deficiency.
• To highlight the importance of patient-specific considerations in reconstructive TKR surgery.

Main Methods:

• Review of current literature on bone stock reconstruction techniques in TKR.
• Analysis of factors influencing treatment decisions, including bone defect characteristics and patient-specific variables.
• Comparison of different reconstructive options such as bone grafts, modular systems, wedges, and augments.

Main Results:

• Various reconstruction techniques show midterm durability but present challenges.
• Concerns include disease transmission, resorption, fracture, immune reactions, cost, and intraoperative inflexibility.
• Modular systems and augments are preferred in cases of septic bone loss to minimize contamination risk.

Conclusions:

• Surgical option selection is guided by bone defect dimensions and patient-related factors.
• Achieving well-aligned, stable implants necessitates adequate restoration of bone stock.
• Successful TKR revision hinges on effectively addressing bone loss and patient-specific needs.