Metaphyseal fixation in revision total knee arthroplasty: Indications and techniques

George J. Haidukewych, Arlen Hanssen, Richard Jones

Research output: Contribution to journalReview articlepeer-review

64 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)311-318
Number of pages8
JournalJournal of the American Academy of Orthopaedic Surgeons
Issue number6
StatePublished - Jun 2011

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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