Bone Defects in Revision Total Knee Arthroplasty and Management

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2019 Feb 28

PMID 30809942

Citations 38

Authors

Peng-Fei Lei

Ru-Yin Hu

Yi-He Hu

Affiliations

Soon will be listed here.

Abstract

This article reviews the recent updates in revision of total knee arthroplasty (RTKA). We reviewed the recent articles on RTKA in databases including PubMed, Google Scholar, and SCOPUS. Total knee arthroplasty (TKA) involves the replacement of all three compartments of the knee in surgery of the knee joint to restore capacity and function. TKA is one of the most common and reliable surgical treatment options for the treatment of knee diseases. However, some patients require revision of TKA (RTKA) after primary TKA for various reasons, including mechanical wear, implant loosening or breakage, malalignment, infection, instability, periprosthetic fracture, and persistent stiffness. Unfortunately, the overall outcome of RTKA is not as satisfactory as for primary TKA due to the uncertainty regarding the actual success rate and the risk factors for failure. Cementation, modular metal augmentation, bone grafting, autologous bone grafting, allogenic bone grafting, impactation bone grafting, structural bone allografting, metaphyseal fixation, using porous titanium coated press fit metaphyseal sleeves and porous tantalum structural cones, and megaprostheses or customized prostheses are the currently available management options for RTKA. However, most of the management systems possess specific complications. Novel approaches should be developed to improve functional capacity, implant survival rates, and quality of life in a cost-efficient manner.

Citing Articles

Varus-Valgus Constrained Prostheses in Revision Total Knee Arthroplasty: A Retrospective Study of Mid- to Long-Term Outcomes.

Hippalgaonkar K, Jayakumar T, Rajeev Reddy K, Mulpur P, Kohli N, Reddy A Cureus. 2025; 17(1):e78273.

PMID: 40026954 PMC: 11872043. DOI: 10.7759/cureus.78273.

Novel Use of Tricortical Iliac Crest Bone Allograft to Reconstruct the Lateral Tibia Plateau Articular Surface: A Case Series.

Schwartz L, Kingery M, Ganta A, Egol K, Konda S J Orthop Case Rep. 2025; 15(2):22-27.

PMID: 39957967 PMC: 11823852. DOI: 10.13107/jocr.2025.v15.i02.5214.

Reliability and utility of the new Belt et al. classification for revision of infected total knee arthroplasty.

Bulzacki Bogucki B, Digennaro V, Cecchin D, Panciera A, Ferri R, Benvenuti L Arch Orthop Trauma Surg. 2025; 145(1):155.

PMID: 39891734 DOI: 10.1007/s00402-025-05769-0.

International, consensus-based, indications and treatment options for knee arthroplasty in acute fractures around the knee.

Rossi S, Andriollo L, Sangaletti R, Montagna A, Benazzo F Arch Orthop Trauma Surg. 2025; 145(1):154.

PMID: 39891727 DOI: 10.1007/s00402-025-05755-6.

Effects of personalized 3D-printed blocks in total knee arthroplasty and revision surgery for massive bone defects: a single-center retrospective study.

Lu F, Li C, Hu P, Hu B, Wu H J Int Med Res. 2025; 53(1):3000605241308383.

PMID: 39772878 PMC: 11707773. DOI: 10.1177/03000605241308383.

References

Engh G, Ammeen D . Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect. 1999; 48:167-75. View

van Loon C, de Waal Malefijt M, Buma P, Stolk T, Verdonschot N, Tromp A . Autologous morsellised bone grafting restores uncontained femoral bone defects in knee arthroplasty. An in vivo study in horses. J Bone Joint Surg Br. 2000; 82(3):436-44. DOI: 10.1302/0301-620x.82b3.9491. View

Werle J, Goodman S, Imrie S . Revision total knee arthroplasty using large distal femoral augments for severe metaphyseal bone deficiency: a preliminary study. Orthopedics. 2002; 25(3):325-7. DOI: 10.3928/0147-7447-20020301-17. View

Suarez-Suarez M, Murcia A, Maestro A . Filling of segmental bone defects in revision knee arthroplasty using morsellized bone grafts contained within a metal mesh. Acta Orthop Belg. 2002; 68(2):163-7. View

Garino J . The use of impaction grafting in revision total knee arthroplasty. J Arthroplasty. 2002; 17(4 Suppl 1):94-7. DOI: 10.1054/arth.2002.32457. View

Reichel H, Hube R, Birke A, Hein W . [Bone defects in revision total knee arthroplasty: classification and management]. Zentralbl Chir. 2002; 127(10):880-5. DOI: 10.1055/s-2002-35134. View

Lonner J, Lotke P, Kim J, Nelson C . Impaction grafting and wire mesh for uncontained defects in revision knee arthroplasty. Clin Orthop Relat Res. 2002; (404):145-51. DOI: 10.1097/00003086-200211000-00026. View

Werner A, Jager M, Schmitz H, Krauspe R . Joint preserving surgery for osteonecrosis and osteochondral defects after chemotherapy in childhood. Klin Padiatr. 2003; 215(6):332-7. DOI: 10.1055/s-2003-45495. View

Patel J, Masonis J, Guerin J, Bourne R, Rorabeck C . The fate of augments to treat type-2 bone defects in revision knee arthroplasty. J Bone Joint Surg Br. 2004; 86(2):195-9. DOI: 10.1302/0301-620x.86b2.13564. View

10.

Ritter M, Harty L . Medial screws and cement: a possible mechanical augmentation in total knee arthroplasty. J Arthroplasty. 2004; 19(5):587-9. DOI: 10.1016/j.arth.2003.11.009. View

11.

Sierra R, Cooney 4th W, Pagnano M, Trousdale R, Rand J . Reoperations after 3200 revision TKAs: rates, etiology, and lessons learned. Clin Orthop Relat Res. 2004; (425):200-6. View

12.

Toms A, McClelland D, Chua L, de Waal Malefijt M, Verdonschot N, Jones R . Mechanical testing of impaction bone grafting in the tibia: initial stability and design of the stem. J Bone Joint Surg Br. 2005; 87(5):656-63. DOI: 10.1302/0301-620X.87B5.15860. View

13.

Dennis D, Little L . The structural allograft composite in revision total knee arthroplasty. Orthopedics. 2005; 28(9):1005-7. DOI: 10.3928/0147-7447-20050901-45. View

14.

Lotke P, Carolan G, Puri N . Impaction grafting for bone defects in revision total knee arthroplasty. Clin Orthop Relat Res. 2006; 446:99-103. DOI: 10.1097/01.blo.0000214414.06464.00. View

15.

Reish T, Clarke H, Scuderi G, Math K, Scott W . Use of multi-detector computed tomography for the detection of periprosthetic osteolysis in total knee arthroplasty. J Knee Surg. 2006; 19(4):259-64. DOI: 10.1055/s-0030-1248116. View

16.

Huff T, Sculco T . Management of bone loss in revision total knee arthroplasty. J Arthroplasty. 2007; 22(7 Suppl 3):32-6. DOI: 10.1016/j.arth.2007.05.022. View

17.

Lotke P, Wong R, Ecker M . The use of methylmethacrylate in primary total knee replacements with large tibial defects. Clin Orthop Relat Res. 1991; (270):288-94. View

18.

Wood G, Naudie D, MacDonald S, McCalden R, Bourne R . Results of press-fit stems in revision knee arthroplasties. Clin Orthop Relat Res. 2008; 467(3):810-7. PMC: 2635433. DOI: 10.1007/s11999-008-0621-9. View

19.

Bauman R, Lewallen D, Hanssen A . Limitations of structural allograft in revision total knee arthroplasty. Clin Orthop Relat Res. 2009; 467(3):818-24. PMC: 2635432. DOI: 10.1007/s11999-008-0679-4. View

20.

Meneghini R, Lewallen D, Hanssen A . Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. Surgical technique. J Bone Joint Surg Am. 2009; 91 Suppl 2 Pt 1:131-8. DOI: 10.2106/JBJS.H.01061. View