Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

Abstract

The number of primary and revision total knee arthroplasties (rTKAs) continues to increase annually. To date, most of the literature has focused on the surgical technique and outcome of revision prostheses. Thanks to the contributions of surgeons, engineers, and researchers, the design of prostheses has reached a prominent milestone. However, very limited discussion regarding the design, rationale and constitution of prostheses has been documented at present. An electronic search of four online databases (Embase, MEDLINE, PubMed, and Google Scholar) was conducted to identify eligible resources. Forty-four review articles were acquired by searching the terms ‘prosthesis selection’, ‘prosthesis option’, and ‘prosthesis determination’ in rTKA. Sixty-eight research articles investigating the factors affecting prosthesis options in rTKA were screened and integrated with the authors’ perspective to reach a final recommendation. This article first discusses the pathological, individual, and other factors affecting prosthesis options in rTKA and further illustrates the classification, geometry, biomechanics, and constitution of the revision system from the authors’ perspective. An evidence-based recommendation in the form of a matching algorithm was formulated. This review offers special value for decision-making regarding prosthesis options in rTKA. Particularly, it presents specific recommendations regarding unclear practical issues, such as the optimal level of constraint, individualized design, length, and fixation of extension stem, as well as the pros and cons of modularity.

Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta‐analysis

“…In general, the similarity in outcome and survivorship observed between CCK and RHK can be attributed to the introduction of a third‐generation RHK, characterised by specific advancements, including a redesigned trochlear groove to enhance patellar tracking and kinematics [26, 27], an enhanced stem design for improved osteointegration, upgraded biomaterials and the addition of a second rotational axis to reduce torsional stress, as previously described [28].…”

Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium

“…Some surgeons advocate for cemented stems while others prefer so-called hybrid fixation (uncemented stems). Each method of fixation has advantages and disadvantages, and each may be appropriate depending on the operative findings (Table 2) [147,158,220].…”

“…However, AORI IIB and III type defects require more sophisticated reconstruction with block and wedge augments, metaphyseal sleeves or cones, and in some cases, custom-made augments [220] The concept of zonal fixation was introduced as a key framework for achieving implant fixation in TKA [147]. Zonal fixation references 3 zones in the distal femur and the proximal tibia.…”

“…In revision TKA, diaphyseal fixation of the femoral and tibial components can be achieved with fully cemented stems or with uncemented stems in a hybrid construct (epiphyseal and metaphyseal cementing). Stem fixation is beneficial to provide load sharing and protect the joint surface from excessive stress and implant loosening [220]. Some surgeons advocate for cemented stems while others prefer so-called hybrid fixation (uncemented stems).…”

Modular Augmentation in Varus-Valgus–Constrained Knee Arthroplasty—Do We Need Sleeves to Avoid Femoral Loosening After Excessive Distal Augmentation?

“…Furthermore, with increasing defect sizes, the need of higher constrained implants becomes more likely. Even with the implantation of semi-constrained components, a much higher stress at the implant-bone interface must be considered [5]. Additional metaphyseal fixation has therefore been introduced to improve implant fixation and overcome the aforementioned shortcomings [6].…”