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Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss

Introduction: a primary goal in revision total knee arthroplasty is to recreate and restore near-normal knee biomechanics by reapproximating the native anatomy. Tibial bone loss poses a challenge for surgeons. Bone cement, bone allograft, screws-in-cement, metaphyseal sleeves or cones, and metallic...

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Autores principales: Jiganti, Max, Tedesco, Nicholas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9863891/
https://www.ncbi.nlm.nih.gov/pubmed/36676786
http://dx.doi.org/10.3390/medicina59010162
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author Jiganti, Max
Tedesco, Nicholas
author_facet Jiganti, Max
Tedesco, Nicholas
author_sort Jiganti, Max
collection PubMed
description Introduction: a primary goal in revision total knee arthroplasty is to recreate and restore near-normal knee biomechanics by reapproximating the native anatomy. Tibial bone loss poses a challenge for surgeons. Bone cement, bone allograft, screws-in-cement, metaphyseal sleeves or cones, and metallic augments are some options for addressing bony deficiency, with endoprosthetic proximal tibia replacement a consideration for the most severe cases. Case Description: we present a case for the novel use of threaded Steinmann pins augmented with cement to reconstruct a massive tibial metaphyseal cortical defect during revision knee arthroplasty. A 76-year-old male presented with an infected primary total knee arthroplasty using MSIS (Musculoskeletal Infection Society) criteria and underwent a standard two-stage revision total knee arthroplasty once the knee was confirmed sterile. Intraoperatively, significant posteromedial and metaphyseal tibial bone loss was identified. In order to avoid proximal tibial replacement and the extensor mechanism complications seen with these, coupled with obligate gastrocnemius flap, a metaphyseal cone was utilized in the proximal tibia with four vertical threaded Steinmann pins spaced approximately 1 cm apart at its periphery, subsequently cut flush with the level of the cone after cementation to recreate the tibial cortex. The patient’s function and range of motion continue to improve with no evidence of structural complication at 2.5 years of follow-up. Discussion: the implementation of threaded Steinmann pins was utilized in this case to stabilize a cemented metaphyseal cone in the revision of an infected total knee with significant tibial bone loss. The threaded property may help prevent migration of these pins in comparison to smooth pins. Creation of a stable platform in a revision total knee arthroplasty poses a substantial challenge in the context of significant bone loss, and our case depicts a good short-term outcome and another option for surgeons to consider before moving toward endoprostheses.
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spelling pubmed-98638912023-01-22 Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss Jiganti, Max Tedesco, Nicholas Medicina (Kaunas) Case Report Introduction: a primary goal in revision total knee arthroplasty is to recreate and restore near-normal knee biomechanics by reapproximating the native anatomy. Tibial bone loss poses a challenge for surgeons. Bone cement, bone allograft, screws-in-cement, metaphyseal sleeves or cones, and metallic augments are some options for addressing bony deficiency, with endoprosthetic proximal tibia replacement a consideration for the most severe cases. Case Description: we present a case for the novel use of threaded Steinmann pins augmented with cement to reconstruct a massive tibial metaphyseal cortical defect during revision knee arthroplasty. A 76-year-old male presented with an infected primary total knee arthroplasty using MSIS (Musculoskeletal Infection Society) criteria and underwent a standard two-stage revision total knee arthroplasty once the knee was confirmed sterile. Intraoperatively, significant posteromedial and metaphyseal tibial bone loss was identified. In order to avoid proximal tibial replacement and the extensor mechanism complications seen with these, coupled with obligate gastrocnemius flap, a metaphyseal cone was utilized in the proximal tibia with four vertical threaded Steinmann pins spaced approximately 1 cm apart at its periphery, subsequently cut flush with the level of the cone after cementation to recreate the tibial cortex. The patient’s function and range of motion continue to improve with no evidence of structural complication at 2.5 years of follow-up. Discussion: the implementation of threaded Steinmann pins was utilized in this case to stabilize a cemented metaphyseal cone in the revision of an infected total knee with significant tibial bone loss. The threaded property may help prevent migration of these pins in comparison to smooth pins. Creation of a stable platform in a revision total knee arthroplasty poses a substantial challenge in the context of significant bone loss, and our case depicts a good short-term outcome and another option for surgeons to consider before moving toward endoprostheses. MDPI 2023-01-13 /pmc/articles/PMC9863891/ /pubmed/36676786 http://dx.doi.org/10.3390/medicina59010162 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Jiganti, Max
Tedesco, Nicholas
Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss
title Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss
title_full Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss
title_fullStr Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss
title_full_unstemmed Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss
title_short Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss
title_sort revision total knee arthroplasty utilizing threaded pins in cement for tibial bone loss
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9863891/
https://www.ncbi.nlm.nih.gov/pubmed/36676786
http://dx.doi.org/10.3390/medicina59010162
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