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[Revision Total Knee Arthroplasty].

Michael Kremer, Yves Gramlich, Reinhard Hoffmann

    Zeitschrift Fur Orthopadie Und Unfallchirurgie
    |September 30, 2020
    PubMed
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    Reconstructing major bone defects in revision total knee arthroplasty (TKA) requires metal augmentation. Stable fixation using metal wedges, sleeves, or cones, with a focus on metaphyseal anchoring, improves outcomes in revision TKA.

    Area of Science:

    • Orthopedic surgery
    • Biomaterials engineering
    • Arthroplasty research

    Background:

    • Revision total knee arthroplasty (TKA) faces challenges including periprosthetic infections (PJI) and significant bony defect reconstruction.
    • Biological reconstruction of major bone defects (AORI II and III) often results in high failure rates.
    • Effective management necessitates ruling out infection pre-operatively and meticulous surgical planning.

    Purpose of the Study:

    • To review current strategies for reconstructing major bony defects during revision total knee arthroplasty (TKA).
    • To evaluate the role of metal augmentation and zonal anchorage principles in improving revision TKA outcomes.
    • To discuss the importance of metaphyseal and diaphyseal anchoring for long-term stability.

    Main Methods:

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  • Review of literature on revision total knee arthroplasty (TKA) focusing on bony defect management.
  • Analysis of the "3-zone model" for zonal anchorage in revision TKA.
  • Evaluation of augmentation techniques including wedges, sleeves, and cones.
  • Discussion of stem anchorage principles (cemented vs. cement-free).

    • Main Results:

    • Sole biological reconstruction of major defects (AORI II and III) demonstrates high failure rates.
    • Metal augmentation (wedges, sleeves, cones) is essential for addressing large bony defects in revision TKA.
    • The "3-zone model" emphasizes stable anchorage in at least two zones, with metaphyseal (zone 2) anchoring being crucial for long-term stability.
    • Cones or sleeves significantly improve revision TKA results, with zone 3 anchorage via stems remaining mandatory.

    Conclusions:

    • Metal augmentation is critical for successful reconstruction of large bony defects in revision TKA.
    • Metaphyseal anchoring (zone 2) is a key factor for achieving stable and durable fixation in revision knee arthroplasty.
    • While both cemented and cement-free stems are available for diaphyseal anchoring (zone 3), no definitive recommendation can be made regarding the preferred method.