Description
Revision total knee replacement presents unique challenges, particularly in the management of bone defects. This webinar will discuss the classification of bone loss and its impact on surgical planning and implant selection. Participants will gain insights into various reconstruction options, including bone grafts, augments, cones, and sleeves. The session will highlight decision-making strategies based on defect size, location, and patient factors. Practical tips, case-based discussions, and recent advances in revision knee arthroplasty will also be covered to improve surgical outcomes.
Summary Listen
- When facing revision total knee replacement, two primary challenges arise: instability and bone defects. Instability is generally addressed with constrained implants offering varying levels of restriction, while bone defects require careful pre-operative evaluation to determine the appropriate implant and bone grafting needs. The interoperative picture is often worse than pre-operative imaging suggests.
- The Anderson Orthopedic Research Institute classification categorizes bone defects, ranging from minor (Type 1) requiring cement or allograft fill, to cancellous bone loss (Type 2) on one or both condyles needing allograft or augments. Type 3 defects extend into the metaphysis; if collateral ligaments are involved, a hinge implant may be needed, while LCCK or TCCC constraints can be used if the ligaments are intact. Securing the implant requires fixation in at least two of three zones: surface, metaphysis, and diaphysis.
- Bone grafting options include impaction bone grafting, suitable for contained defects using cancellous and cortical bone chips. It restores bone stock, although it is a difficult and time-consuming technique prone to graft resorption and unsuitable in cases of infection. Massive allografts are another option, particularly for severe metaphyseal bone loss; however, graft availability, virus transmission, and long-term survival remain concerns.
- Trabecular metal, a porous and flexible material, promotes bone in-growth. It provides a stable construct and is machinable to some extent. However, it requires cementation and, while osteo-inductive, does not directly load the bone. Metaphyseal sleeves fill dead space, provide immediate fixation, and load the bone, promoting new bone formation, and are independent of implant alignment
- Rotating platform (RP) implants are typically used with sleeves in revision. This uncouples torsional forces from flexion-extension forces and reduces stress on the implant, minimizing loosening.
Sample Certificate
About the Speakers
Dr. Buddha Deb Chatterjee
Consultant Orthopaedics, Apollo Multispeciality Hospitals, Kolkata
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