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Management of bone loss in revision total knee arthroplasty: therapeutic options and results

The treatment of small to moderate size defects in revision total knee arthroplasty (rTKA) has yielded good results with various techniques (cement and screws, small metal augments, impaction bone grafting and modular stems). However, the treatment of severe defects remains problematic. Severe defec...

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Autores principales: Rodríguez-Merchán, E. Carlos, Gómez-Cardero, Primitivo, Encinas-Ullán, Carlos A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Editorial Society of Bone and Joint Surgery 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8631235/
https://www.ncbi.nlm.nih.gov/pubmed/34909226
http://dx.doi.org/10.1302/2058-5241.6.210007
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author Rodríguez-Merchán, E. Carlos
Gómez-Cardero, Primitivo
Encinas-Ullán, Carlos A.
author_facet Rodríguez-Merchán, E. Carlos
Gómez-Cardero, Primitivo
Encinas-Ullán, Carlos A.
author_sort Rodríguez-Merchán, E. Carlos
collection PubMed
description The treatment of small to moderate size defects in revision total knee arthroplasty (rTKA) has yielded good results with various techniques (cement and screws, small metal augments, impaction bone grafting and modular stems). However, the treatment of severe defects remains problematic. Severe defects have typically been treated with large allograft and metaphyseal sleeves. The use of structural allograft has decreased in recent years due to increased long-term failure rates and the introduction of highly porous metal augments (cones and sleeves). A systematic review of level IV evidence studies on the outcomes of rTKA metaphyseal sleeves found a 4% rate of septic revision, and a rate of septic loosening of the sleeves of 0.35%. Aseptic re-revision was required in 3% of the cases. The rate of aseptic loosening of the sleeves was 0.7%, and the rate of intraoperative fracture was 3.1%. The mean follow-up was 3.7 years. Another systematic review of tantalum cones and sleeves found a reoperation rate of 9.7% and a 0.8% rate of aseptic loosening per sleeve. For cones, the reoperation rate was 18.7%, and the rate of aseptic loosening per cone was 1.7%. The reported survival of metal sleeves was 99.1% at three years, 98.7% at five years and 97.8% at 10 years. The reported survival free of cone revision for aseptic loosening was 100%, and survival free of any cone revision was 98%. Survival free of any revision or reoperation was 90% and 83%, respectively. Cite this article: EFORT Open Rev 2021;6:1073-1086. DOI: 10.1302/2058-5241.6.210007
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spelling pubmed-86312352021-12-13 Management of bone loss in revision total knee arthroplasty: therapeutic options and results Rodríguez-Merchán, E. Carlos Gómez-Cardero, Primitivo Encinas-Ullán, Carlos A. EFORT Open Rev Knee The treatment of small to moderate size defects in revision total knee arthroplasty (rTKA) has yielded good results with various techniques (cement and screws, small metal augments, impaction bone grafting and modular stems). However, the treatment of severe defects remains problematic. Severe defects have typically been treated with large allograft and metaphyseal sleeves. The use of structural allograft has decreased in recent years due to increased long-term failure rates and the introduction of highly porous metal augments (cones and sleeves). A systematic review of level IV evidence studies on the outcomes of rTKA metaphyseal sleeves found a 4% rate of septic revision, and a rate of septic loosening of the sleeves of 0.35%. Aseptic re-revision was required in 3% of the cases. The rate of aseptic loosening of the sleeves was 0.7%, and the rate of intraoperative fracture was 3.1%. The mean follow-up was 3.7 years. Another systematic review of tantalum cones and sleeves found a reoperation rate of 9.7% and a 0.8% rate of aseptic loosening per sleeve. For cones, the reoperation rate was 18.7%, and the rate of aseptic loosening per cone was 1.7%. The reported survival of metal sleeves was 99.1% at three years, 98.7% at five years and 97.8% at 10 years. The reported survival free of cone revision for aseptic loosening was 100%, and survival free of any cone revision was 98%. Survival free of any revision or reoperation was 90% and 83%, respectively. Cite this article: EFORT Open Rev 2021;6:1073-1086. DOI: 10.1302/2058-5241.6.210007 British Editorial Society of Bone and Joint Surgery 2021-11-19 /pmc/articles/PMC8631235/ /pubmed/34909226 http://dx.doi.org/10.1302/2058-5241.6.210007 Text en © 2021 The author(s) https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Knee
Rodríguez-Merchán, E. Carlos
Gómez-Cardero, Primitivo
Encinas-Ullán, Carlos A.
Management of bone loss in revision total knee arthroplasty: therapeutic options and results
title Management of bone loss in revision total knee arthroplasty: therapeutic options and results
title_full Management of bone loss in revision total knee arthroplasty: therapeutic options and results
title_fullStr Management of bone loss in revision total knee arthroplasty: therapeutic options and results
title_full_unstemmed Management of bone loss in revision total knee arthroplasty: therapeutic options and results
title_short Management of bone loss in revision total knee arthroplasty: therapeutic options and results
title_sort management of bone loss in revision total knee arthroplasty: therapeutic options and results
topic Knee
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8631235/
https://www.ncbi.nlm.nih.gov/pubmed/34909226
http://dx.doi.org/10.1302/2058-5241.6.210007
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