Managing bone defects in primary total knee arthroplasty: options and current trends

Aggarwal, Aditya; Baburaj, Vishnu

doi:10.1007/s12306-020-00683-7

Cited by 15 publications

(22 citation statements)

References 29 publications

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“…In addition, there is a risk of friction, corrosion, stress shielding with bone loss, and the formation of radiolucent lines, and the application is problematic in case of severe cancellous bone damage. Also, many patients complain of dissatisfaction and pain after metal augmentation [12,[19][20][21][22][23][24][25][26][27]. Sleeves can be inserted both cemented and uncemented.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Tsamassiotis

Ettinger

2021

Case Reports in Surgery

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Charcot arthropathy of the knee is an extremely rare orthopedic disease that is very challenging for the treating physician and is associated with many complications, especially if it is occurring on both knees. Meanwhile, in the advanced stage, despite many potential complications, TKA is recognized as the gold standard. However, destruction of the medial tibial plateau is typical for the disease, which makes a stable anchorage of the prosthesis much more difficult. Therefore, we present a case in which sufficient primary stability could be achieved with an asymmetrical second-generation tibial cone with an anatomical design and implantation instruments adapted to the bony anatomy in the presence of severe tibial destruction on both sides. In the two-year follow-up, the patient showed good mobility and stability on both sides. In advanced Charcot arthropathy of the knee, the use of asymmetric tibial cones appears to be an appropriate solution for secure fixation and stability of the implant.

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Section: Discussionmentioning

confidence: 99%

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Tsamassiotis

Ettinger

2021

Case Reports in Surgery

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“…По-другому дело обстоит с большими дефектами, при которых уже необходимо усиливать фиксацию в диафизарной зоне, и это является прямым показанием к использованию удлиняющей ножки. Металлическая аугментация зарекомендовала себя не только как надежный способ замещения дефекта медиального мыщелка большеберцовой кости, но и как один из наиболее часто используемых методов борьбы с потерей костной массы [46].…”

Section: Discussionunclassified

“…Метод замещения костного дефекта металлическими блоками молодым пациентам с хорошим качеством кости не может быть рекомендован как вариант предпочтительного выбора, так как при обработке ложа под аугмент теряется и здоровая кость, а также металлический блок не восстанавливает костный запас [46,57]. В то же время при плохом качестве кости метод восполнения дефекта костными материалами увеличивает риск несращения и лизиса трансплантата и не может быть рекомендован [11].…”

Section: Discussionunclassified

“…Учитывая результаты проведенного анализа публикаций, а также зональную фиксацию компонента эндопротеза, мы модифицировали предложенный A.K. Aggarwal с соавторами [46] рабочий алгоритм подхода к замещению костных дефектов (рис. 2).…”

Section: Discussionunclassified

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Methods of the Tibia Bone Defect Management in Primary Knee Arthroplasty: Systematic Review

Gurazhev

Baitov

Гаврилов

et al. 2021

Traumatology and Orthopedics of Russia

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Background. The problem of management of bone tissue defects remains one of the tasks that a surgeon faces during primary total knee arthroplasty (TKA). Since the number of TKA is increasing every year, modern scientific research aimed at solving the problem of bone defect replacement remains important. The aim of the study was to evaluate the effectiveness of various methods of bone defects management in primary TKA based on the analysis of literature. Materials and Methods. We conducted a search of articles in PubMed, eLIBRARY, Scopus from 2005 to 2020. Results. On the whole our search led to 1217 papers. Finally 19 articles that met inclusion criteria were included in this review. Each of the methods of bone defect replacement has its advantages and disadvantages. The results of the studies show that the he defect size is not a key factor for choosing the method, since with relatively identical defect parameters, different plastic options were used with a satisfactory clinical outcome. The endoprosthesis component should be fixed in at least two zones in every chosen method. In young patients with good bone quality preference in chosen methods should be given to bone grafts, which allow to preserve the bone stock. Based on the papers analysis, we have proposed the algorithm for method choosing for each clinical case. Conclusion. Each surgeon chooses a method for replacing bone defects based on their own preferences and such criteria as the equipment of the operating room, the surgical team experience, the quality of the patients bone and the defect size.

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“…As one of the most effective remedial procedures, total knee revision (TKR) is widely recognized in addressing bone defects following total knee arthroplasty ( Theil et al, 2021 ). According to the Anderson Orthopedic Research Institute (AORI) classification of bone defects ( Aggarwal and Baburaj, 2020 ), AORI type 3 bone defects, which create severe knee dysfunction, often involve femoral condyles and tibial plateau. The management of AORI type 3 bone defects in TKR remains complicated due to a lack of restoration procedures that perfectly fit the sizes of the defects ( Sheth et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison Between Porous Ti6Al4V Block and Tumor Prosthesis UHMWPE Block for the Treatment of Distal Femur Bone Defects

Zhang

Liu

Han

et al. 2022

Front. Bioeng. Biotechnol.

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Purpose: The management of bone defects is a crucial content of total knee revision. This study compared the biomechanical performance of porous Ti6Al4V block and tumor prosthesis UHMWPE block in treating distal femoral bone defects.Methods: The finite element models of AORI type 3 distal femoral bone defect treated with porous Ti6Al4V block and UHMWPE block were established. Sensitivity analysis was performed to obtain the appropriate mesh size. The biomechanical performance of treatment methods in bone defects were evaluated according to the peak stress, the Von Mises stress distribution, and the average stresses of regions of interest under the condition of standing on one foot and flexion of the knee. Statistical analysis was conducted by independent samples t-test in SPSS (p < 0.05).Results: In the standing on one-foot state, the peak stress of the porous Ti6Al4V block was 12.42 MPa and that of the UHMWPE block was 19.97 MPa, which is close to its yield stress (21 MPa). Meanwhile, the stress distribution of the UHMWPE block was uneven. In the flexion state, the peak stress of the porous Ti6Al4V block was 16.28 MPa, while that of the UHMWPE block was 14.82 MPa. Compared with the porous Ti6Al4V block group, the average stress of the region of interest in UHMWPE block group was higher in the standing on one foot state and lower in the flexion state (p < 0.05).Conclusion: More uniform stress distribution was identified in the porous Ti6Al4V block application which could reserve more bone. On the contrary, uneven stress distribution and a larger high-stress concentration area were found in the UHMWPE block. Hence, the porous Ti6Al4V block is recommended for the treatment of AORI type 3 distal femoral bone defect.

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Managing bone defects in primary total knee arthroplasty: options and current trends

Cited by 15 publications

References 29 publications

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Methods of the Tibia Bone Defect Management in Primary Knee Arthroplasty: Systematic Review

Biomechanical Comparison Between Porous Ti6Al4V Block and Tumor Prosthesis UHMWPE Block for the Treatment of Distal Femur Bone Defects

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