Distal Femoral Replacement in Nontumor Cases with Severe Bone Loss and Instability

Berend, Keith R.; Lombardi, Adolph V.

doi:10.1007/s11999-008-0329-x

Cited by 125 publications

(107 citation statements)

References 32 publications

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“…Options have included the use of impaction bone-grafting [22,25,38,40,44], structural bulk allografts [7,11,14,16,17,28,31,39], and tumor-type megaprostheses [2]. Studies with structural allografts and tumor megaprostheses during revision knee arthroplasty have reported encouraging mid-term results, but the high number of complications is a concern.…”

Section: Discussionmentioning

confidence: 99%

“…Major tibial and femoral bone defects, classified as Anderson Orthopaedic Research Institute (AORI) [10] Types 2B and 3, have been reconstructed using impaction bone grafting with or without mesh augmentation [22,25,38,40,44], structural or bulk allografts [7,11,14,16,17,28,31,39], modular metal augmentations of prostheses [15,32], and tumor-type megaprostheses [2]. Studies using structural allografts have reported numerous complications and minimum 5-year survivorship of 67% to 96% [1,6,7,14,17], whereas reconstructions with tumor-type megaprostheses have shown a 5-year survivorship of 68% [33].…”

Section: Introductionmentioning

confidence: 99%

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Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Martino

Santis

Sculco

et al. 2015

Clin Orthop Relat Res

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Background Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions. Questions/purposes We wished to determine the midterm (1) reoperation rates for septic and aseptic causes, (2) radiologic findings of osseointegration, and (3) clinical outcomes based on the Knee Society score in patients who underwent revision knee arthroplasty with tantalum cones for severe bone loss. Methods We retrospectively evaluated records of 18 patients (18 knees) who underwent revision knee arthroplasty with use of tantalum cones between 2005 and 2008; the primary indications for use of this approach were to reconstruct massive bone defects classified as Anderson Orthopaedic Research Institute Types 2B and 3. During this period, all defects of this type were treated with this approach and no cones were used for more-minor defects. A total of 26 cones (13 tibial and 13 femoral) were implanted. There were 12 female and six male patients with a mean age of 73 years (range, 55-84 years) at the time of revision. The indication for the revision included aseptic loosening (five patients) and second-stage reimplantation for deep infection (13 patients). Patients were followed for a mean of 6 years (range, 5-8 years). No patient was lost to followup. Clinical and radiographic outcomes were assessed with the Knee Society clinical rating system and radiographic evaluation system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Martino

Santis

Sculco

et al. 2015

Clin Orthop Relat Res

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“…Management of severe bone loss is dependent on the degree and location of the defect. Options are cement filling, use of metal augmentation, bone grafting or in severe cases mega prostheses [3].…”

Section: Introductionmentioning

confidence: 99%

Bone mineral density changes of the proximal tibia after revision total knee arthroplasty. A randomised study with the use of porous tantalum metaphyseal cones

Jensen

Petersen

Schrøder

et al. 2012

International Orthopaedics (SICOT)

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Purpose Forty patients were enrolled in a prospective randomised study using conventional method or "Trabecular Metal Cone" (TM Cone) (Zimmer inc., Warsaw, USA) for reconstruction of bone loss of the proximal tibia during revision total knee arthroplasty (rTKA). The aim was to evaluate changes in bone mineral density (BMD) at the proximal tibia. Material and methods Thirty-six patients [median 67 years (range: 40-85 years)] received rTKA with NexGen® (Zimmer Warsaw, USA) revision system. Knee Society´s Knee Scoring System and the Anderson Orthopaedic Research Institute (AORI) bone classification was used. Changes in BMD were measured by dual energy X-ray absorptiometry (DEXA). Results Knee and function score improved in both groups. No significant changes between the groups were found. Changes in BMD within the two groups were quite similar. Overall decreases in BMD of 0.1 -5.4 % were found in both groups (ROI 1-6) postoperative to 12 months of follow-up, except that ROI 7 showed an increase in BMD (0.8 -1.3 %).

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“…There was no incidence of aseptic loosening at mean follow up of 46 months with 87% survivorship. There were five reoperations, including two patients with recurrent infection after two-stage treatment, one patient with a periprosthetic fracture treated by open reduction and internal fixation, one patient with late hematogenous infection, and one patient with bearing exchange to treat hyperextension [46].…”

Section: Revision Total Knee Arthroplastymentioning

confidence: 99%

“…Fracture union is often delayed in these patients and close follow up is required [6,29]. If nonunion is of specific concern due to host factors, indirect reduction techniques and sub muscular plating or DFR should be chosen [46,52]. Patient specific complications include extensor mechanism disruption, infection, and implant failure.…”

Section: Complicationsmentioning

confidence: 99%

Periprosthetic Distal Femur Fractures: Review of Current Treatment Options

Head

2018

ReconRev

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The geriatric population in general and specifically recipients of total knee arthroplasty (TKA) have increasing functional demands along with an increasing life expectancy. Certain intraoperative aspects of the index procedure, revision TKA, or the patient's physiology (i.e.-osteoporosis, rheumatoid arthritis, neurologic disease) predispose the patient to post-operative periprosthetic distal femur fractures (PDFF). This review describes the epidemiology, classification, examination, and treatment options of PDFF. Osteoporosis and intraoperative anterior femoral cortex notching are primary patient and surgeon specific factors, respectively. The two most commonly used classification systems were described by Rorabeck and Kim and should be used to guide the surgeon's choice of treatment. The non-operative treatment of PDFF is rare, requires close radiographic follow up, and delayed union is common. Open reduction with internal fixation (ORIF) is best accomplished with minimally invasive techniques and distal locking screws. Retrograde, intra-medullary nail fixation is technically difficult, but provides earlier weight bearing and comparable time to union as ORIF. Revision TKA is indicated in patients with adequate bone stock, a simple fracture pattern without ligamentous instability, and a loose or malaligned femoral component. Allograftprosthetic composite (APC) or distal femoral replacement (DFR) is indicated for patients presenting with a PDFF about poor or deficient bone stock. Patients with PDFF present a challenge to the arthroplasty surgeon in regards to choice of treatment and increased morbidity and mortality post-operatively. Close follow up is required and fracture union is often delayed.

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Distal Femoral Replacement in Nontumor Cases with Severe Bone Loss and Instability

Cited by 125 publications

References 32 publications

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Bone mineral density changes of the proximal tibia after revision total knee arthroplasty. A randomised study with the use of porous tantalum metaphyseal cones

Periprosthetic Distal Femur Fractures: Review of Current Treatment Options

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