Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 4/2014

01-04-2014 | Knee Revision Surgery

Bone loss following knee arthroplasty: potential treatment options

Authors: Michele Vasso, Philippe Beaufils, Simone Cerciello, Alfredo Schiavone Panni

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2014

Login to get access

Abstract

Introduction

The management of bone loss is a crucial aspect of the revision knee arthroplasty. Bone loss can hinder the correct positioning and alignment of the prosthetic components, and can prevent the achievement of a stable bone–implant interface. There is still controversy regarding the optimal management of knee periprosthetic bone loss, especially in large defects for which structural grafts, metal or tantalum augments, tantalum cones, porous metaphyseal sleeves, and special prostheses have been advocated. The aim of this review was to analyze all possible causes of bone loss and the most advanced strategies for managing bony deficiency within the knee joint reconstruction.

Materials and methods

Most significant and recent papers about the management of bone defects during revision knee arthroplasty were carefully analyzed and reviewed to report the most common causes of bone loss and the most effective strategies to manage them.

Results

Modular metal and tantalum augmentation showed to provide more stable and durable knee revisions compared to allografts, limited by complications such as graft failure, fracture and resorption. Moreover, modular augmentation may considerably shorten operative times with a potential decrease of complications, above all infection which has been frequently associated to the use of allografts.

Conclusions

Modular augmentation may significantly reduce the need for allografting, whose complications appear to limit the long-term success of knee revisions.
Literature
1.
Alexander GE, Bernasek TL, Crank RL, Haidukewych GJ (2013) Cementless metaphyseal sleeves used for large tibial defects in revision total knee arthroplasty. J Arthroplast 28:604–607CrossRef
2.
Huten D (2013) Femorotibial bone loss during revision total knee arthroplasty. Orthop Traumatol Surg Res 99(1 Suppl):S22–S33PubMedCrossRef
3.
Rao BM, Kamal TT, Vafaye J, Moss M (2013) Tantalum cones for major osteolysis in revision knee replacement. Bone Joint J 95:1069–1074PubMedCrossRef
4.
Dalury DF, Pomeroy DL, Gorab RS, Adams MJ (2013) Why are total knee arthroplasties being revised? J Arthroplast 28(8 Suppl):120–121CrossRef
5.
Kasahara Y, Majima T, Kimura S, Nishiike O, Uchida J (2013) What are the causes of revision total knee arthroplasty in Japan? Clin Orthop Relat Res 471:1533–1538PubMedCrossRef
6.
Gallo J, Goodman SB, Konttinen YT, Wimmer MA, Holinka M (2013) Osteolysis around total knee arthroplasty: a review of pathogenetic mechanisms. Acta Biomater 9:8046–8058PubMedCrossRef
7.
Wiggers EC, Johnson W, Tucci M, Benghuzzi H (2011) Biochemical and morphological changes associated with macrophages and osteoclasts when challenged with infection—biomed 2011. Biomed Sci Instrum 47:183–188PubMed
8.
Chen J, Cui Y, Li X, Miao X, Wen Z, Xue Y, Tian J (2013) Risk factors for deep infection after total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 133:675–687PubMedCrossRef
9.
Goldvasser D, Marchie A, Bragdon LK, Bragdon CR, Weidenhielm L, Malchau H (2013) Incidence of osteolysis in total knee arthroplasty: comparison between radiographic and retrieval analysis. J Arthroplast 28:201–206CrossRef
10.
Kendrick BJ, Simpson DJ, Kaptein BL, Valstar ER, Gill HS, Murray DW, Price AJ (2011) Polyethylene wear of mobile-bearing unicompartmental knee replacement at 20 years. J Bone Joint Surg 93:470–475CrossRef
11.
Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX (2013) Is there reduced polyethylene wear and longer survival when using a mobile-bearing design in total knee replacement? A meta-analysis of randomised and non-randomised controlled trials. Bone Joint J 95:1057–1063PubMedCrossRef
12.
Lachiewicz PF, Geyer MR (2011) The use of highly cross-linked polyethylene in total knee arthroplasty. J Am Acad Orthop Surg 19:143–151PubMed
13.
Schiavone Panni A, Vasso M, Cerciello S, Maccauro G (2011) Metallosis following knee arthroplasty: a histological and immunohistochemical study. Int J Immunopathol Pharmacol 24:711–719PubMed
14.
Citak M, Gessmann J, Fehmer T, Russe O, Schildhauer TA, Seybold D (2011) Two-stage revision of infected total knee arthroplasty using a distraction spacer. Technol Health Care 19:167–171PubMed
15.
Johnson AJ, Sayeed SA, Naziri Q, Khanuja HS, Mont MA (2012) Minimizing dynamic knee spacer complications in infected revision arthroplasty. Clin Orthop Relat Res 470:220–227PubMedCentralPubMedCrossRef
16.
Romanò CL, Gala L, Logoluso N, Romanò D, Drago L (2012) Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc 20:2445–2453PubMedCrossRef
17.
Nettrour JF, Polikandriotis JA, Bernasek TL, Gustke KA, Lyons ST (2013) Articulating spacers for the treatment of infected total knee arthroplasty: effect of antibiotic combinations and concentrations. Orthopedics 36:19–24CrossRef
18.
Rogers BA, Middleton FR, Shearwood-Porter N, Kinch S, Roques A, Bradley NW, Browne M (2011) Does cyclical loading affect the elution of antibiotics from articulating cement knee spacers? J Bone Joint Surg 93:914–920CrossRef
19.
Silvestre A, Almeida F, Renovell P, Morante E, López R (2013) Revision of infected total knee arthroplasty: two-stage reimplantation using an antibiotic-impregnated static spacer. Clin Orthop Surg 5:180–187PubMedCentralPubMedCrossRef
20.
Engh GA, Ammeen D (1998) Classification and preoperative radiographic evaluation: knee. Orthop Clin North Am 29:205–217PubMedCrossRef
21.
Rand JA (1991) Bone deficiency in total knee arthroplasty: use of metal wedge augmentation. Clin Orthop Relat Res 271:63–71PubMed
22.
Daines BK, Dennis DA (2013) Management of bone defects in revision total knee arthroplasty. Instr Course Lect 62:341–348PubMed
23.
Gudnason A, Milbrink J, Hailer NP (2011) Implant survival and outcome after rotating-hinge total knee revision arthroplasty: a minimum 6-year follow-up. Arch Orthop Trauma Surg 131:1601–1607PubMedCrossRef
24.
25.
Schmitz HC, Klauser W, Citak M, Al-Khateeb H, Gehrke T, Kendoff D (2013) Three-year follow up utilizing tantal cones in revision total knee arthroplasty. J Arthroplast 28:1556–1560CrossRef
26.
Vasso M, Beaufils P, Schiavone Panni A (2013) Constraint choice in revision knee arthroplasty. Int Orthop 37:1279–1284PubMedCrossRef
27.
Hanna SA, Aston WJ, de Roeck NJ, Gough-Palmer A, Powles DP (2011) Cementless revision TKA with bone grafting of osseous defects restores bone stock with a low revision rate at 4 to 10 years. Clin Orthop Relat Res 469:3164–3171PubMedCentralPubMedCrossRef
28.
Hongvilai S, Tanavalee A (2012) Review article: management of bone loss in revision knee arthroplasty. J Med Assoc Thai 95(Suppl 10):S230–S237PubMed
29.
Naim S, Toms AD (2013) Impaction bone grafting for tibial defects in knee replacement surgery. Results at two years. Acta Orthop Belg 79:205–210PubMed
30.
Hilgen V, Citak M, Vettorazzi E, Haasper C, Day K, Amling M, Gehrke T, Gebauer M (2013) 10-year results following impaction bone grafting of major bone defects in 29 rotational and hinged knee revision arthroplasties: a follow-up of a previous report. Acta Orthop 84:387–391PubMedCentralPubMedCrossRef
31.
Howard JL, Kudera J, Lewallen DG, Hanssen AD (2011) Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg Am 93:478–484PubMedCrossRef
32.
Lachiewicz PF, Bolognesi MP, Henderson RA, Soileau ES, Vail TP (2012) Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res 470:199–204PubMedCentralPubMedCrossRef
33.
Haidukewych GJ, Hanssen A, Jones RD (2011) Metaphyseal fixation in revision total knee arthroplasty: indications and techniques. J Am Acad Orthop Surg 19:311–318PubMed
34.
Beckmann J, Lüring C, Springorum R, Köck FX, Grifka J, Tingart M (2011) Fixation of revision TKA: a review of the literature. Knee Surg Sports Traumatol Arthrosc 19:872–879PubMedCrossRef
35.
36.
Steens W, Loehr JF, Wodtke J, Katzer A (2008) Morselized bone grafting in revision arthroplasty of the knee: a retrospective analysis of 34 reconstructions after 2–9 years. Acta Orthop 79:683–688PubMedCrossRef
37.
Lotke PA, Carolan GF, Puri N (2006) Impaction grafting for bone defects in revision total knee arthroplasty. Clin Orthop Relat Res 446:99–103PubMedCrossRef
38.
Ghazavi MT, Stockley I, Yee G, Davis A, Gross AE (1997) Reconstruction of massive bone defects with allograft in revision total knee arthroplasty. J Bone Joint Surg Am 79:17–25PubMedCrossRef
39.
Backstein D, Safir O, Gross A (2006) Management of bone loss: structural grafts in revision total knee arthroplasty. Clin Orthop Relat Res 446:104–112PubMedCrossRef
40.
Clatworthy MG, Ballance J, Brick GW, Chandler HP, Gross AE (2011) The use of structural allograft for uncontained defects in revision total knee arthroplasty: a minimum five-year review. J Bone Joint Surg Am 83:404–411
41.
42.
Brand MG, Daley RJ, Ewald FC, Scott RD (1989) Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency. Clin Orthop Relat Res 248:71–79PubMed
43.
Haas SB, Insall JN, Montgomery W 3rd, Windsor RE (1995) Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg Am 77:1700–1707PubMed
44.
Werle JR, Goodman SB, Imrie SN (2002) Revision total knee arthroplasty using large distal femoral augments for severe metaphyseal bone deficiency: a preliminary study. Orthopedics 25:325–327PubMed
45.
Patel JV, Masonis JL, Guerin J, Bourne RB, Rorabeck CH (2004) The fate of augments to treat type-2 bone defects in revision knee arthroplasty. J Bone Joint Surg 86:195–199CrossRef
46.
Wood GC, Naudie DD, MacDonald SJ, McCalden RW, Bourne RB (2009) Results of press-fit stems in revision knee arthroplasties. Clin Orthop Relat Res 467:810–817PubMedCentralPubMedCrossRef
47.
Meneghini RM, Lewallen DG, Hansesen AD (2008) Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am 90:78–84PubMedCrossRef
48.
49.
Qiu YY, Yan CH, Chiu KY, Ng FY (2012) Review article: treatments for bone loss in revision total knee arthroplasty. J Orthop Surg 20:78–86
50.
Wang JW, Hsu CH, Huang CC, Lin PC, Chen WS (2013) Reconstruction using femoral head allograft in revision total knee replacement: an experience in Asian patients. Bone Joint J 95-B:643–648PubMedCrossRef
51.
Richards CJ, Garbuz DS, Pugh L, Masri BA (2011) Revision total knee arthroplasty: clinical outcome comparison with and without the use of femoral head structural allograft. J Arthroplast 26:1299–1304CrossRef
Metadata
Title
Bone loss following knee arthroplasty: potential treatment options
Authors
Michele Vasso
Philippe Beaufils
Simone Cerciello
Alfredo Schiavone Panni
Publication date
01-04-2014
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 4/2014
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-014-1941-8

Other articles of this Issue 4/2014

Archives of Orthopaedic and Trauma Surgery 4/2014 Go to the issue

Orthopaedic Surgery

Peroneus quartus: prevalance and clinical importance

Knee Arthroplasty

The effect of femoral component design on patellar tracking in total knee arthroplasty: Genesis II prosthesis versus Vanguard prosthesis

Hip Arthroplasty

Comparison of bacterial results from conventional cultures of the periprosthetic membrane and the synovial or pseudocapsule during hip revision arthroplasty

Erratum

Erratum to: Poor outcome at 7.5 years after Stanisavljevic quadriceps transposition for patello-femoral instability

Knee Revision Surgery

The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods

Orthopaedic Surgery

Poor outcome at 7.5 years after Stanisavljevic quadriceps transposition for patello-femoral instability