Management of Bone Defects in Revision Total Knee Arthroplasty

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Presentation transcript:

Management of Bone Defects in Revision Total Knee Arthroplasty by Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am Volume 94(12):1131-1139 June 20, 2012 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Preoperative anteroposterior radiograph. Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative photographs demonstrating an extensive cavitary defect (arrow) managed with particulate allografting (bottom). Intraoperative photographs demonstrating an extensive cavitary defect (arrow) managed with particulate allografting (bottom). Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph made thirteen years postoperatively. Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Preoperative lateral radiograph showing osseous defect (arrows). Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative photographs demonstrating a Type-IIA osseous defect of the lateral femoral condyle (top) managed with a tructural femoral head allograft (bottom). Intraoperative photographs demonstrating a Type-IIA osseous defect of the lateral femoral condyle (top) managed with a tructural femoral head allograft (bottom). Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Postoperative lateral radiograph made eight years after reconstruction of the structural allograft. Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Photograph of the various tibial metaphyseal sleeves (top) available to treat Type-II and III osseous defects, and intraoperative photograph (bottom) of the proximal part of the tibia following broaching for a metaphyseal sleeve, demonstrating precise defec... Photograph of the various tibial metaphyseal sleeves (top) available to treat Type-II and III osseous defects, and intraoperative photograph (bottom) of the proximal part of the tibia following broaching for a metaphyseal sleeve, demonstrating precise defect preparation. (The image on the bottom is reproduced, with permission of Elsevier from: Dennis DA. A stepwise approach to revision total knee arthroplasty. J Arthroplasty. 2007 Jun;22(4 Suppl 1):32-8. Copyright 2007.)‏ Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Preoperative anteroposterior (left) and lateral (right) radiographs showing many 8-mm cement plugs in the femur (arrow) and tibia. Preoperative anteroposterior (left) and lateral (right) radiographs showing many 8-mm cement plugs in the femur (arrow) and tibia. Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior (left) and lateral (right) radiographs following reconstruction with a diaphyseal-engaging stem and femoral and tibial metaphyseal sleeves. Postoperative anteroposterior (left) and lateral (right) radiographs following reconstruction with a diaphyseal-engaging stem and femoral and tibial metaphyseal sleeves. Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Preoperative anteroposterior (left) and lateral (right) radiographs showing the fractures of the medial and lateral condyles (arrows). Preoperative anteroposterior (left) and lateral (right) radiographs showing the fractures of the medial and lateral condyles (arrows). Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior (left) and lateral (right) radiographs following reconstruction with a distal femoral condyle-replacing hinged prosthesis. Postoperative anteroposterior (left) and lateral (right) radiographs following reconstruction with a distal femoral condyle-replacing hinged prosthesis. Brian K. Daines, and Douglas A. Dennis J Bone Joint Surg Am 2012;94:1131-1139 ©2012 by The Journal of Bone and Joint Surgery, Inc.