N°268 - Book 2 - November 2017
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Revision total knee replacement: a new approach to manage bone tissue loss
By Sébastien Parratte*, Matthew P. Abdel **, Alexandre Lunebourg*, Matthieu Ollivier*, Jean-Noël Argenson* in category
*Institut de Locomotion, Hôpital St. Marguerite - 13274 Marseille, France [email protected] / ** Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905
Total knee arthroplasty is very successful and is likely to be even more so in the future [1, 2].
Moreover, the number of revision total knee replacements (TKRs) is expected to increase by fivefold between now and 2030 [1, 2].
The latest studies show that the seven most common reasons for revision surgery are aseptic loosening (23.1%), infection (18.4%), polyethylene wear (18.1%), instability (17.7%), pain/stiffness (9.3%), osteolysis (4.5%), and malalignment (2.9%) [1,3]. With modern implants, mechanical stresses can be managed effectively .
One of the main challenges in revision TKR is the management of severe bone loss . Traditionally, allografts have been widely used to minimise loss of bone tissue or to reconstruct the extensor mechanism, but with a significant failure rate at medium-term follow-up .
New techniques stemming largely from the Mayo Clinic School have been developed to improve revision TKR outcomes [4, 5, 6, 7, 8]. The aim of this article is to present current technical solutions to repair severe bone loss in revision TKR.
What are the issues with bone defects in revision TKR?
The goal of revision TKR is to restore limb function with a stable, mobile, and pain-free knee. To do that, the surgeon must overcome three problems: 1- implant...
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