N°276 - August/September 2018
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Review of experience: Revision total knee prosthesis with metaphyseal sleeve
By Dorik Passeron, Simon Marmor in category FOLLOW-UP
Service de Chirurgie Orthopédique, Groupe hospitalier Diaconesses Croix Saint Simon, Paris.
The number of total knee arthroplasties is growing rapidly. Numbers are predicted to be more than 250,000 per year in the United States by 2030, with a growth of 673%.(1) The number of revision knee replacements will therefore increase correspondingly, whether due to mechanical reasons or infections.
The main difficulties in revisions are bone stock management and finding zones capable of bearing weight. In practice, there are three possible zones for revisions: the epiphyseal zone, which is often deficient; the metaphyseal zone, which is the main weight-bearing zone; and the diaphyseal zone, which may pose problems for treatment escalation (Fig. 1).(2)
In the case of significant bone loss, several options have been explored:
- Reconstruction by allograft has up to 33% risk of failure in the first 5 years (3), but some publications indicate better results.(4) However, this technique is difficult and not very reproducible.(5)
- Adding wedges and the use of stems of variable length and varying degrees of offset is a more classic solution.(6)(7) The stems can be cemented, but are hard to extract or clean in the event of infection (6), or they can be uncemented....
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