Management of bone loss during revision hip or knee replacement:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1998
|
| Series: | The orthopedic clinics of North America
29,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XI S., S. 173 - 376 zahlr. Ill., graph. Darst. |
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| adam_text | MANAGEMENT OF BONE LOSS DURING
REVISION HIP OR KNEE REPLACEMENT
CONTENTS
Preface xiii
Clive P. Duncan and Robert B. Bourne
Pathogenesis of Bone Loss After Total Hip Arthroplasty 173
Harry E. Rubash, Raj K. Sinha, Arun S. Shanbhag, and Shin Yoon Kim
Bone loss with or without evidence of aseptic loosening is a long term
complication after total hip arthroplasty (THA). It occurs with all materials
and in all prosthetic systems in use or that have been used to date. Bone
loss after THA can be a serious problem in revision surgery because bone
deficiencies may limit reconstructive options, increase the difficulty of
surgery, and necessitate autogenous or allogenic bone grafting. There are
three factors adversely affecting maintenance of bone mass after THA: (1)
bone loss secondary to particulate debris; (2) adaptive bone remodeling
and stress shielding secondary to size, material properties, and surface
characteristics of contemporary prostheses; and (3) bone loss as a conse¬
quence of natural aging. This chapter reviews the mechanisms of the
primary causes of bone loss after THA.
The Pathogenesis of Bone Loss Following Total Knee Arthroplasty 187
Peter L. Lewis, Nigel T. Brewster, and Stephen E. Graves
Bone loss following total knee arthroplasty (TKA) may be focal or diffuse.
It may be caused mechanically, either by unloading of the bone leading to
disuse osteoporosis, or by overloading of the bone leading to trabecular
fractures and bone destruction. Osteolysis, instigated by an inflammatory
reaction to particulate wear debris, is an important and common cause of
bone loss after TKA. Less common, though sometimes dramatic, causes of
bone loss are infection and osteonecrosis.
Biology of Allografting 199
Donald S. Garbuz, Bassam A. Masri, and Andrei A. Czitrom
Allograft bone continues to play an important role in revision hip and
knee arthroplasty. A basic understanding of allograft biology and immu¬
nology is important in order to increase the success of allografting. This
THE ORTHOPEDIC CLINICS OF NORTH AMERICA
VOLUME 29 • NUMBER 2 • APRIL W8 Vli
article will review current knowledge of allograft biology and immunol¬
ogy
Classification and Preoperative Radiographic Evaluation: Knee 205
Gerard A. Engh and Deborah J. Ammeen
The failure of total knee arthroplasty (TKA) results in the presence of some
degree of bone loss at the time of revision surgery. A classification system
to describe the extent of bone loss assists the surgeon in planning the
revision surgery. The Anderson Orthopaedic Research Institute (AORI)
bone defect classification system includes three basic categories of bone
loss and provides a basis for determining the need for stemmed compo¬
nents, augments, or bone grafts. Type 1 defects (intact metaphyseal bone)
can be effectively managed by using primary components; Type 2 defects
(damaged metaphyseal bone) are best managed with modular revision
components; and Type 3 defects (deficient metaphyseal bone) require the
lost bone to be reconstructed with structural bone graft(s), custom, or
hinged components.
The Classification and Radiographic Evaluation of Bone Loss in
Revision Hip Arthroplasty 219
Bassam A. Masri, Eric L. Masterson, and Clive P. Duncan
Many classification systems have been described over the past ten years
for bone loss which is found in association with the failed hip arthroplasty.
Most are based on assessments of bone stock which are made intra
operatively. Good quality plain radiography is the most useful preopera¬
tive investigation and provides important information regarding the resid¬
ual bone stock. There is a need for critical appraisal of the validity of
classification systems currently in use and the development of a consensus
system which will permit comparison between the published results of
different techniques.
Seven Specialized Exposures for Revision Hip and Knee
Replacement 229
Bassam A. Masri, David G. Campbell, Donald S. Garbuz, and
Clive P. Duncan
With the increasing rates and complexity of revision hip and knee
arthroplasty, it has become more important than ever to approach the joint
in a safe and rational manner. The development of extensile approaches
have significantly simplified the removal of solidly fixed components
without compromising bone stock. The extended trochanteric osteotomy
enables controlled access to the femoral component and is a useful tech¬
nique for revision of solidly fixed femoral components. The trochanteric
slide allows comprehensive exposure of the acetabulum and femur compa¬
rable to trochanteric osteotomy with a diminished risk of trochanteric
escape. The vastus slide allows wide exposure of the femoral shaft when
using an anterolateral approach.
In revision total knee arthroplasty, the extensor mechanism is often at
risk of disruption or avulsion, and in most cases, maneuvers that allow
wide exposure of the femur and tibia while preserving the extensor mecha¬
nism are essential. Such exposures include one of the extensor mechanism
reflecting techniques either proximally by rectus snip or patellar turndown,
or distally by tibial tubercle osteotomy. Occasionally a femoral peel or
epicondylar osteotomy is required. There should be a low threshold to
consider one of these specialized approaches during revision hip and knee
arthroplasty.
viii CONTENTS
Role and Results of the High Hip Center 241
Michael Tanzer
Anatomic placement of the acetabular component should be the surgeon s
goal at the time of revision THA. However, Acetabular loosening with
subsequent implant migration, progressive superior acetabular bone de¬
struction or severe pelvic osteolysis, may prevent the surgeon from ob¬
taining adequate host bone implant contact needed for a successful recon¬
struction while maintaining a normal hip center. The high hip center
offers a technique for reconstruction of an acetabulum with severe bony
deficiency and where the majority of the remaining host bone is superior
to the anatomic hip centre.
Jumbo Cups and Morselized Graft 249
Murali Jasty
Revision of failed acetabular components presents a formidable problem
due to associated loss of bone and sclerosis of the remaining bone. Unce
mented acetabular components with porous surfaces have revolutionized
acetabular revision surgery. They can be stabilized into the existing host
bone with supplemental screws even in the face of major bone loss. Non
structural particulate bone grafts can then be used to supplement the bone
stock. With large defects, jumbo acetabular components ranging in sizes
from 70 to 80 millimeter outer diameters can be stabilized on the acetabu¬
lar rim while the defects can be grafted with morsalized bone. Nineteen of
such revisions performed for major bone loss without pelvic discontinuity
between February 1986 and December 1988 were evaluated at a mean
follow up period of ten years (range eight to eleven years). One component
had been revised for sepsis. None of the others had been revised. Definite
radiographic failure of fixation of the acetabular component was not seen
on any of the other hips. These results strongly support the use of jumbo
uncemented acetabular components with morsalized bone grafts even in
the face of major acetabular bone loss.
Reconstruction Rings and Bone Graft in Total Hip Revision Surgery 255
Miguel E. Cabanela
This article deals with the design and indications of use of reconstruction
rings and cages plus bone graft for acetabular revision. Details of the
technique and the available results are presented and the advantages and
disadvantages of current designs are discussed.
Role and Results of Segmental Allografts for Acetabular Segmental
Bone Deficiency 263
Donald S. Garbuz and Murray J. Penner
Acetabular reconstruction in both primary and revision hip arthroplasty
often requires reconstruction of deficient acetabular bone stock. The exact
role of allografts remains controversial. Published results of structural
allografting are presented. Recent literature supports the use of segmental
allografts for reconstruction of large segmental and combined defects.
Modified Cups 277
Hugh U. Cameron
Late results of structural allografting of the acetabulum are quite variable.
In order to reduce or avoid the necessity for bone grafting, some modified
cups have been developed. The deep cup with or without a lateralized
polyethylene liner reduces the problem of the protrusio socket. Oblong or
bilobed ingrowth cups significantly reduce the need for grafting of the
roof deficient acetabulum. Constrained or capture polyethylene liners are
useful in the unstable hip.
CONTENTS ix
Impaction Allografting with Cement for the Management of Femoral
Bone Loss 297
Clive P. Duncan, Bassam A. Masri, and Eric L. Masterson
Impaction allografting with cement is the only technique currently avail¬
able which reverses the diminution of bone stock that occurs in a revision
hip arthroplasty, and as such, has great potential. It is particularly appro¬
priate in the younger patient, though older patients may also benefit from
the technique. Although the short term results are encouraging, there is a
need for further basic science research to determine the optimal graft
material and prosthesis design. Refinements in surgical instrumentation
and technique will continue to improve the predictability of the clinical
result and expand the indications for this important addition to the avail¬
able options in revision hip arthroplasty.
Onlay Cortical Allografting for the Femur 307
William C. Head, Theodore I. Malinin, Thomas H. Mallory, and
Roger H. Emerson, Jr
Failed femoral total hip replacement components are frequently associated
with bone loss. At the time of revision surgery, the goals are to create a
construct that relieves pain, is stable, and preserves and enhances bone
stock. This article discusses Materials and Methods, Indications, Operative
Technique, and Results regarding onlay cortical allografting for the femur.
Proximal Femoral Allografts for Reconstruction of Bone Stock in
Revision Arthroplasty of the Hip 313
Allan E. Gross and Carol R. Hutchison
Full circumferential bone loss of the proximal femur can be managed by
segmental allografts. The use of these grafts is indicated for uncontained
defects longer than five cm in length. The femoral implant is cemented
into the allograft but not into the host. The allograft host junction is
stabilized by a step cut or oblique osteotomy and autografted with residual
host femur. The results at five and nine years support this kind of recon¬
struction as a good alternative for this difficult problem.
Bypass Fixation 319
Ram Aribindi, Mark Barba, Michael I. Solomon, Peggy Arp, and
Wayne Paprosky
Hip replacement has been a great achievement of orthopaedic surgery as
it reliably abolishes pain and restores function. The success of this opera¬
tion has lead to its use not only in the elderly, but increasingly, in the
higher demand that younger patients whose life expectancy is longer than
the longetevity of the prostheses used to date. Thus, we are seeing a
growing number of patients who require a first or even repeat revision
surgery, which is often complex and technically demanding.
Principles of Revision Total Knee Arthroplasty 331
Robert B. Bourne and H.A. Crawford
Revision total knee replacements (TKRs) have traditionally represented
approximately 5% of all total knee replacements performed. Poor implant
design features have increased the prevalence of revision TKRs to ten or
more percent in some centers. This article briefly describes the investiga¬
tion for the failure mechanism of a total knee joint replacement and
outlines the principles of revision surgery.
X CONTENTS
The Role and Results of Bone Grafting in Revision Total Knee
Replacement 339
Thomas P. Sculco and Joon C. Choi
Failure in total knee replacement requiring revision surgery is often accom¬
panied by significant bone loss and soft tissue asymmetry. When em¬
barking on these complex reconstructions, careful preoperative planning
is necessary to ensure that these deficiencies will be corrected by surgical
technique and implant selection. This article discusses various techniques
and results of bone grafting in revision total knee arthroplasty.
Modular Augments in Revision Total Knee Arthroplasty 347
James A. Rand
Modularity in total knee arthroplasty is extremely helpful in the manage¬
ment of patients with complex primary and revision total knee arthroplas
ties. Modularity allows selective augmentation to deal with bone deficien¬
cies on the distal and posterior femur. The ability to selectively augment
the femur is very helpful in balancing the soft tissues and providing
stability. Selective augmentation of the femur allows restoration of the
joint line and more normal patellar and collateral ligament kinematics.
Selective modular augments on the tibia allow dealing with bone defi¬
ciency without the concerns of bone graft incorporation. Modular extended
intramedullary stems allow the option of either press fit or cement fixation
of the stem, entailing the stem diameter length to the given patient.
Management of the Patella During Revision Total Knee Replacement
Arthroplasty 355
Richard S. Laskin
Managing the patella and balancing the patellofemoral joint space is one
of the most difficult aspects of performing a primary total knee replace¬
ment (TKR). The situation is compounded in the revision situation. Unfor¬
tunately, an otherwise well performed TKR will fail because of problems
with the patella or the extensor mechanism. This article discusses various
aspects of the management of the patella and extensor mechanism during
revision TKR with an objective of minimizing complications and maximiz¬
ing functional outcomes. The topics covered include exposure of the pa¬
tella and extensor mechanism during revision surgery, whether or not to
remove all prior patellar implants, the technique for removal of a prior
implant, the management of bone loss or fractures of the patella during
revision TKR, the insertion (or noninsertion) and fixation of a new implant,
and the balance of the patellofemoral joint space, including avoidance of
patella baja or patella alta. A compilation of scientific and no so scientific
data and experience gleaned over the past 26 years of total knee replace¬
ment surgery will be presented.
Results of Revision Total Knee Arthroplasty in the Face of
Significant Bone Deficiency 361
Cecil H. Rorabeck and Paul N. Smith
In the case of primary total knee arthroplasty, the goals of revision knee
arthroplasty are restoration of the joint line to as near as possible to
the normal state, correct anatomic alignment of the components, and a
satisfactorily stable and desireable construct. This article discusses the
problems of the multiply operated knee, and offers guidelines for future
management.
Index 373
Subscription Information Inside back cover
CONTENTS Xi
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| spellingShingle | Management of bone loss during revision hip or knee replacement The orthopedic clinics of North America Reoperation (DE-588)4225285-4 gnd Kniegelenkprothese (DE-588)4031297-5 gnd Hüftgelenkprothese (DE-588)4026034-3 gnd Implantatlockerung (DE-588)4238116-2 gnd Osteodystrophie (DE-588)4207133-1 gnd |
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| title | Management of bone loss during revision hip or knee replacement |
| title_auth | Management of bone loss during revision hip or knee replacement |
| title_exact_search | Management of bone loss during revision hip or knee replacement |
| title_full | Management of bone loss during revision hip or knee replacement Clive P. Duncan ... guest ed. |
| title_fullStr | Management of bone loss during revision hip or knee replacement Clive P. Duncan ... guest ed. |
| title_full_unstemmed | Management of bone loss during revision hip or knee replacement Clive P. Duncan ... guest ed. |
| title_short | Management of bone loss during revision hip or knee replacement |
| title_sort | management of bone loss during revision hip or knee replacement |
| topic | Reoperation (DE-588)4225285-4 gnd Kniegelenkprothese (DE-588)4031297-5 gnd Hüftgelenkprothese (DE-588)4026034-3 gnd Implantatlockerung (DE-588)4238116-2 gnd Osteodystrophie (DE-588)4207133-1 gnd |
| topic_facet | Reoperation Kniegelenkprothese Hüftgelenkprothese Implantatlockerung Osteodystrophie Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008019382&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000001089 |
| work_keys_str_mv | AT duncanclivep managementofbonelossduringrevisionhiporkneereplacement |