Individual Revision Knee Arthroplasty Is a Safe Limb Salvage Procedure

Abstract

Introduction: Revision total knee arthroplasty after multiple pre-surgeries is challenging. Due to severe bone defects, standard implants for metaphyseal and diaphyseal anchoring may no longer be suitable. The primary aim of this case series is to evaluate the early complication rate for individual knee implants with custom-made cones and stems after two-stage revision with severe bone defects. Methods: Ten patients who were treated with custom-made 3D-printed knee revision implants were included. Inclusion criteria were a two-stage revision due to late-onset or chronic periprosthetic joint infection as well as aseptic loosening. All severe bone defects were AORI type III. All procedure-related complications were evaluated. Postoperative range of motion after one year was measured. The time between the two surgeries was evaluated. Results: The mean follow-up was 21 months (range: 12–40). The mean time between the two-stage surgeries was 71.6 days. No fractures were observed intra- and postoperatively. Two patients were revised without changing metal components due to persistent hematoma (three weeks post-surgery) and persistent PJI (three months post-surgery). The mean passive postoperative range of motion was 92° (range: 80–110°). Conclusions: Individual custom-made implants for rTKA provide a safe procedure for patients with huge bone defects after several pre-surgeries. If standard knee systems with standard cones or sleeves are not suitable anymore, custom-made treatment offers the patient the last option for limb preservation. However, this is associated with increased costs.

Custom-Made Metaphyseal Sleeves in “Beyond” AORI III Defects for Revision Knee Arthroplasty—Proof of Concept and Short-Term Results of a New Technique

“…They showed a low rate of complications (n = 1) and only reported functional outcomes in three patients (OKS: 41;43;38) [14]. Using a similar treatment approach, Savov et al reported results in 10 patients with 9 custom-made tibial cones, showing a low complication rate (n = 2) at a mean follow-up of 21 months, though no functional outcome parameters were reported [19]. Li et al published a study using a similar method in seven patients with good functional outcomes at a follow-up of 25 months (postoperative HSS: 78 (70-83) (p < 0.01)) [20].…”

“…While the literature suggests that cones and sleeves might be used interchangeably in smaller defects, we have specifically opted for the use of custom-made sleeves and not cones in our collective due to several factors. The implantation of a CMS should only be indicated when sufficient epiphyseal fixation is no longer possible and metaphyseal fixations are highly compromised [8,19]. In these cases, long-term implant survival can only be achieved by osteointegrative fixation in zones II and III [5].…”

“…Furthermore, in these complex cases, a high offset is often required to achieve anatomical and biomechanical reconstruction, as seen in our collective, with a mean offset of 9.5 (SD: 4; range: 4-15) mm. Using a custom-made cone achieving diaphyseal reconstruction (zone III) requires a cemented implant due to the limited stem size, as seen in the collective by Savov et al [19]. As osteointegrative fixation in zone II is mandatory for the long-term survival of the prosthesis, an exacting cementing technique must be consistently conducted.…”

Results of Revision Knee Arthroplasty With Individual Implants

“…В настоящее время все чаще в хирургической практике используются индивидуально изготовленные имплантаты для лечения пациентов с наличием обширных костных дефектов [15]. Однако выбор метода, как правило, определяется предпочтениями хирурга и непосредственной доступностью каждой из технологий в определенном лечебном учреждении [16].…”

Taking the Next Step in Personalised Orthopaedic Implantation

“…This has been the case for decades, but the techniques that are available to us are becoming more and more sophisticated and allow better restorations [ 3 , 4 , 5 , 6 ]. The same is actually true for defects in revision arthroplasty and spinal surgery [ 7 , 8 , 9 ]. Since more and more revisions are re-revisions, the defects and collateral damage become bigger with every episode of loosening and consecutive operation.…”