TY - JOUR
T1 - Metaphyseal fixation in revision total knee arthroplasty
T2 - Indications and techniques
AU - Haidukewych, George J.
AU - Hanssen, Arlen
AU - Jones, Richard
PY - 2011/6
Y1 - 2011/6
N2 - The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durable, stable, well-functioning revision TKA include bony deficiency, periarticular osteopenia, deformity, and soft-tissue imbalance. Defect management often requires the use of stems, cement, metal augmentation, or allograft. Recently, there has been interest in obtaining fixation in the metaphyseal region in an attempt to improve construct stability while managing bony deficiency. Often, the metaphyseal bone is well vascularized, which provides an opportunity for additional fixation with cement, allograft, trabecular metal cones, or stepped porous-coated sleeves. Multiple series have documented good survivorship at short-term follow-up with trabecular metal cones and porous-coated sleeves. These newer technologies offer biologic fixation and are useful for treating bony defects that are not easily managed with other methods. Long-term studies are needed to determine the durability of these constructs. Concerns persist regarding stress shielding and difficulty of removal. Familiarity with the rationale and strategies for metaphyseal fixation in revision TKA is a valuable addition to the armamentarium of the revision surgeon.
AB - The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durable, stable, well-functioning revision TKA include bony deficiency, periarticular osteopenia, deformity, and soft-tissue imbalance. Defect management often requires the use of stems, cement, metal augmentation, or allograft. Recently, there has been interest in obtaining fixation in the metaphyseal region in an attempt to improve construct stability while managing bony deficiency. Often, the metaphyseal bone is well vascularized, which provides an opportunity for additional fixation with cement, allograft, trabecular metal cones, or stepped porous-coated sleeves. Multiple series have documented good survivorship at short-term follow-up with trabecular metal cones and porous-coated sleeves. These newer technologies offer biologic fixation and are useful for treating bony defects that are not easily managed with other methods. Long-term studies are needed to determine the durability of these constructs. Concerns persist regarding stress shielding and difficulty of removal. Familiarity with the rationale and strategies for metaphyseal fixation in revision TKA is a valuable addition to the armamentarium of the revision surgeon.
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U2 - 10.5435/00124635-201106000-00001
DO - 10.5435/00124635-201106000-00001
M3 - Review article
C2 - 21628642
AN - SCOPUS:79959333827
SN - 1067-151X
VL - 19
SP - 311
EP - 318
JO - Journal of the American Academy of Orthopaedic Surgeons
JF - Journal of the American Academy of Orthopaedic Surgeons
IS - 6
ER -