Management of femur and tibia metaphyseal bone defects during revision total knee arthroplasty – methods and outcomes (review)

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Abstract

Total knee arthroplasty (TKA) is becoming an increasingly common treatment for a wide variety of diseases, as well as treatment for consequences from knee injury. The number of primary joint replacement operations have been steadily climbing. As a result, the number of revision procedures have also grown, accounting for 6–8% of arthroplasties. The problem of bone defects compensation remains one of the greatest challenges faced by the surgeon during revision TKA and usually requires a comprehensive approach, careful preoperative planning and preparation. The compensation of small, in depth and extent, bone defects (AORI Type I and II) does not present serious difficulties and their methods are well developed. Whereas the compensation of massive defects (Type 3) is extremely difficult. Until recently, structural allografts were the only method available to surgeons and still remain relevant and demonstrate good results. In recent years, as an alternative, it has become possible to use sleeves and cones made of porous metal, which are also showing very promising mid-term results. This review demonstrates the results from recent studies of mid-term and long-term outcomes of revision TKA, in which different methods of bone defect compensation were used. The clinical evidence did not demonstrate any obvious advantage of using one method over another, therefore, research in this area continues to remain relevant.

About the authors

G. Y. Bovkis

Vreden Russian Research Institute of Traumatology and Orthopedics, ul. Ak. Baykova, 8, St. Petersburg, Russia, 195427

Author for correspondence.
Email: dr.Bovkis@mail.ru

researcher of knee pathology department of Vreden Russian Research Institute of Traumatology and Orthopaedics

Russian Federation

T. A. Kulyaba

Vreden Russian Research Institute of Traumatology and Orthopedics, ul. Ak. Baykova, 8, St. Petersburg, Russia, 195427

Email: fake@neicon.ru

head of knee pathology department of Vreden Russian Research Institute of Traumatology and Orthopaedics

Russian Federation

N. N. Kornilov

Vreden Russian Research Institute of Traumatology and Orthopedics, ul. Ak. Baykova, 8, St. Petersburg, Russia, 195427

Mechnikov North Western State Medical University, Kirochnaya ul., 41, St. Petersburg, Russia, 191015

Email: fake@neicon.ru

professor of chair of traumatology and orthopaedics of Vreden Russian Research Institute of Traumatology and Orthopaedics, associate professor of department of traumatology and orthopaedics of Mechnikov North Western State Medical University

Russian Federation

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