Predictors of Bone Loss in Revision Total Knee Arthroplasty

Michael R Bloomfield; Alison K Klika; Ho H Lee; David M Joyce; Priyesh Mehta; Wael K Barsoum

doi:10.1055/s-0030-1262323

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2010; 23(1): 051-055
DOI: 10.1055/s-0030-1262323

Predictors of Bone Loss in Revision Total Knee Arthroplasty

Michael R. Bloomfield¹ , Alison K. Klika¹ , Ho H. Lee¹ , David M. Joyce¹ , Priyesh Mehta¹ , Wael K. Barsoum¹

¹Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio

Abstract

ABSTRACT

Revision total knee arthroplasty (RTKA) requires preoperative planning to enable the reconstruction of bony deficiencies. The objective of this project was to identify predictors of bone loss management at RTKA based on the preoperative failure mode and patient demographics known preoperatively. We retrospectively reviewed 245 consecutive RTKA procedures in which the same revision knee system was utilized. Patient demographic and treatment data were recorded, and locations of bone loss were identified based on the reconstructive management. We identified significant predictors for use of femoral augments at all four positions. Several predictors significantly predisposed to use of a thick (>19 mm) polyethylene; however, no predictors of tibial augments were significant. Although the reconstruction of bone loss is primarily based on the intraoperative assessment, these findings may provide additional information to help the surgeon prepare for difficult revision procedures.

KEYWORDS

Bone loss - revision total knee arthroplasty - reconstruction

Full Text

References

REFERENCES

1 Clarke H D, Scuderi G R. Revision total knee arthroplasty: planning, management, controversies, and surgical approaches. Instr Course Lect. 2001; 50 359-365
2 Font-Rodriguez D E, Scuderi G R, Insall J N. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997; (345) 79-86
3 Windsor R E, Scuderi G R, Moran M C, Insall J N. Mechanisms of failure of the femoral and tibial components in total knee arthroplasty. Clin Orthop Relat Res. 1989; (248) 15-19 discussion 19-20
4 Mahoney O M, Kinsey T L. 5- to 9-year survivorship of single-radius, posterior-stabilized TKA. Clin Orthop Relat Res. 2008; 466 436-442
5 Vessely M B, Whaley A L, Harmsen W S, Schleck C D, Berry D J. The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res. 2006; 452 28-34
6 Parsch D, Krüger M, Moser M T, Geiger F. Follow-up of 11-16 years after modular fixed-bearing TKA. Int Orthop. 2009; 33 431-435
7 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005; 87 1487-1497
8 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89 780-785
9 Lavernia C, Lee D J, Hernandez V H. The increasing financial burden of knee revision surgery in the United States. Clin Orthop Relat Res. 2006; 446 221-226
10 Ritter M A, Carr K D, Keating E M, Faris P N, Bankoff D L, Ireland P M. Revision total joint arthroplasty: does Medicare reimbursement justify time spent?. Orthopedics. 1996; 19 137-139
11 Clatworthy M GGA. Management of bony defects in revision total knee replacement. In: Callaghan JJ RA, Rubash HE, Simonian PT, Wickiewicz TL The Adult Knee. Philadelphia; Lippincott, Williams and Wilkins 2003: 1455-1463
12 Radnay C S, Scuderi G R. Management of bone loss: augments, cones, offset stems. Clin Orthop Relat Res. 2006; 446 83-92
13 Sharkey P F, Hozack W J, Rothman R H, Shastri S, Jacoby S M. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res. 2002; (404) 7-13
14 Whittaker J P, Dharmarajan R, Toms A D. The management of bone loss in revision total knee replacement. J Bone Joint Surg Br. 2008; 90 981-987
15 Backstein D, Safir O, Gross A. Management of bone loss: structural grafts in revision total knee arthroplasty. Clin Orthop Relat Res. 2006; 446 104-112
16 Engh G A, Ammeen D J. Use of structural allograft in revision total knee arthroplasty in knees with severe tibial bone loss. J Bone Joint Surg Am. 2007; 89 2640-2647
17 Hockman D E, Ammeen D, Engh G A. Augments and allografts in revision total knee arthroplasty: usage and outcome using one modular revision prosthesis. J Arthroplasty. 2005; 20 35-41
18 Brooks P J, Walker P S, Scott R D. Tibial component fixation in deficient tibial bone stock. Clin Orthop Relat Res. 1984; (184) 302-308
19 Brand M G, Daley R J, Ewald F C, Scott R D. Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency. Clin Orthop Relat Res. 1989; (248) 71-79
20 Pagnano M W, Trousdale R T, Rand J A. Tibial wedge augmentation for bone deficiency in total knee arthroplasty. A followup study. Clin Orthop Relat Res. 1995; (321) 151-155
21 Rand J A. Bone deficiency in total knee arthroplasty. Use of metal wedge augmentation. Clin Orthop Relat Res. 1991; (271) 63-71
22 Werle J R, Goodman S B, Imrie S N. Revision total knee arthroplasty using large distal femoral augments for severe metaphyseal bone deficiency: a preliminary study. Orthopedics. 2002; 25 325-327
23 Engh Jr C A, McAuley J P, Sychterz C J, Sacco M E, Engh Sr C A. The accuracy and reproducibility of radiographic assessment of stress-shielding. A postmortem analysis. J Bone Joint Surg Am. 2000; 82-A 1414-1420
24 Bush J L, Wilson J B, Vail T P. Management of bone loss in revision total knee arthroplasty. Clin Orthop Relat Res. 2006; 452 186-192
25 Pour A E, Parvizi J, Slenker N, Purtill J J, Sharkey P F. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am. 2007; 89 1735-1741

Alison K KlikaM.S.

Department of Orthopaedic Surgery, Cleveland Clinic

9500 Euclid Avenue, Cleveland, OH 44195

Email: klikaa@ccf.org