Megaprosthesis in Knee Arthroplasty Revision for Non Oncologic Patient: A Narrative Review

In knee reconstructive surgery, total knee arthroplasty (TKA) is a well-established and successful procedure, with a substantial worldwide increase in the number of procedures performed, driven by an aging population and expanding indications. Consequently, a growing challenge in modern arthroplasty surgery is the progressively increasing cumulative burden of complex revision TKA (rTKA), which often involves severe periprosthetic bone loss, a history of multiple previous surgical failures, periprosthetic joint infections (PJI), periprosthetic fractures (PPFs), or ligamentous instability with disruption of the extensor mechanism. In these highly compromised scenarios, megaprostheses, originally developed for limb salvage following musculoskeletal tumor resections in orthopedic oncology, have emerged as a valuable salvage technique and have been progressively adapted for demanding non-oncological reconstructive revision procedures. Despite the increasing adoption of megaprostheses, clinical decision-making in non-oncological rTKA remains a topic of ongoing debate. A clear consensus regarding precise clinical indications, advantages and disadvantages, and long-term survival rates compared with alternative reconstructive techniques is still evolving. The aim of this review article is to specifically analyze the current literature regarding the indications, outcomes, and rates and types of complications associated with megaprosthetic reconstruction in revision total knee arthroplasty, providing orthopedic surgeons with an evidence-based framework for patient selection and surgical planning.