Purpose. Cementless cup with
INTRODUCTION. Allograft reconstruction after resection of primary bone sarcomas has a non-union rate of approximately 20%. Achieving a wide surface area of contact between host and allograft bone is one of the most important factors to help reduce the non-union rate. We developed a novel technique of haptic robot-assisted surgery to reconstruct bone defects left after primary bone sarcoma resection with
Massive bone loss on both the femur and tibia during revision total knee arthroplasty (TKA) remains a challenging problem. Multiple solutions have been proposed for small osseous defects, including morselised cancellous bone grafting, small-fragment
The management of bone loss in revision total knee replacement (TKA) remains a challenge. To accomplish the goals of revision TKA, the surgeon needs to choose the appropriate implant design to “fix the problem,” achieve proper component placement and alignment, and obtain robust short- and long-term fixation. Proper identification and classification of the extent of bone loss and deformity will aid in preoperative planning. Extensive bone loss may be due to progressive osteolysis (a mechanism of failure), or as a result of intraoperative component removal. The Anderson Orthopaedic Research Institute (AORI) is a useful classification system that individually describes femoral and tibial defects by the appearance, severity, and location of bone defects. This system provides a guideline to treatment and enables preoperative planning on radiographs. In Type 1 defects, femoral and tibial defects are characterised by minor contained deficiencies at the bone-implant interface. Metaphyseal bone is intact and the integrity of the joint line is not compromised. In this scenario, the best reconstruction option is to increase the thickness of bone resection and to fill the defect with cancellous bone graft or cement. Type 2 defects are characterised by deficient metaphyseal bone involving one or more femoral condyle(s) or tibial plateau(s). The peripheral rim of cortical bone may be intact or partially compromised, and the joint line is abnormal. Reconstruction options for a Type 2A defect include impaction bone grafting, cement, or more commonly, prosthetic augmentation (e.g. sleeves, augments or wedges). In Type 2B defects, metaphyseal bone of both femoral condyles or both tibial plateaus is deficient. The peripheral rim of cortical bone may be intact or partially compromised, and the joint line is abnormal. Options for a Type 2B defect include impaction grafting, bulk
The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised knee. Topics covered will include: (1) Exposure in the multiply operated knee (when to use quad snip, tibial tubercle osteotomy, other techniques); (2) Implant removal: Tips for removing stemmed implants; (3) Management of bone loss in multiply operated knees (metal cones/sleeves vs.
Metaphyseal bone loss, due to loosening, osteolysis or infection, is common with revision total knee arthroplasty (TKA). Small defects can be treated with screws and cement, bone graft, and non-porous metal wedges or blocks. Large defects can be treated with bulk
The goals of revision arthroplasty of the hip are to restore the anatomy and achieve stable fixation for new acetabular and femoral components. It is important to restore bone stock, thereby creating an environment for stable fixation for the new components. The bone defects encountered in revision arthroplasty of the hip can be classified either as contained (cavitary) or uncontained (segmental). Contained defects on both the acetabular and femoral sides can be addressed by morselised bone graft that is compacted into the defect. Severe uncontained defects are more of a problem particularly on the acetabular side where bypass fixation such as distal fixation on the femoral side is not really an alternative. Most authors agree that the use of morselised allograft bone for contained defects is the treatment of choice as long as stable fixation of the acetabular component can be achieved and there is a reasonable amount of contact with bleeding host bone for eventual ingrowth and stabilisation of the cup. On the femoral side, contained defects can be addressed with impaction grafting for very young patients or bypass fixation in the diaphysis of the femur using more extensively coated femoral components or taper devices. Segmental defects on the acetabular side have been addressed with
Femoral components in total hip replacements fail in well-known ways. There is vertical sink, posterior rotation and pivot, either distal or mid-stem. In order to sink, the stem moves into valgus and then slides down the inside of the calcar. It does not cut through the calcar. To prevent sink and pivot, a canal filling stem is required. Canal fill prevents the stem from moving into valgus and, therefore, it will not sink. Two centimeters with complete canal fill is adequate in a primary stem. A long stem will give longer canal fill in a revision. Sharp distal flutes will prevent rotation. The distal end of the stem should be polished. One is looking for a distal stability, not distal fixation. If the isthmus is intact, a primary stem can be used. If the isthmus is damaged, a long stem is necessary. If the calcar is intact, a primary neck is adequate. If the calcar is missing down to the level of the lesser trochanter, a calcar replacement neck is required. If there is more than 70 millimeters of completely missing proximal femur, a
Impaction grafting is an excellent option for acetabular revision. It is technique specific and very popular in England and the Netherlands and to some degree in other European centers. The long term published results are excellent. It is, however, technique dependent and the best results are for contained cavitary defects. If the defect is segmental and can be contained by a single mesh and impaction grafting, the results are still quite good. If, however, there is a larger segmental defect of greater than 50% of the acetabulum or a pelvic discontinuity, other options should be considered. Segmental defects of 25–50% can be managed by minor column (shelf) or figure of 7
Metaphyseal bone loss, due to loosening, osteolysis or infection, is common with revision total knee arthroplasty (TKA). Small defects can be treated with screws and cement, bone graft, and non-porous metal wedges or blocks. Large defects can be treated with bulk
In North America, and for the most part globally, a cementless acetabular component with adjuvant screw fixation is the preferred technique for revision total hip arthroplasty. However, there are situations that involve massive pelvic bone loss that preclude the use of a cementless cup alone. Options include:
. i). Enhanced fixation components and augments. ii). Specialised constructs (cup/cage). iii).
Restoration of bone loss is a major challenge of revision TKA surgery. It is critical to achieve of a stable construct to support implants and achieve successful results. Major bone defects of the femoral and/or tibia (AORI type IIB/III) have been reconstructed using impaction grafting,
Segmental defects of the acetabulum are often encountered in revision surgery. Many times these can be handled with hemispherical cups. However when larger defects are encountered particularly involving the dome and/or posterior wall structural support for the cup is often needed. In the past
The S-ROM stem is distally circular canal filling with thin sharp flutes which engage the endosteal cortex. The rotational stability produced by this is 37 Nm, which exceeds the service loads on the hip of 22 Nm. The distal canal fill prevents varus and valgus displacement. The porous-coated proximal sleeve provides resistance to vertical sink and also excludes the distal stem from the effective joint space. The primary stem is straight and the long stem is bowed with a 15 degrees anteversion twist proximally. The neck comes in lengths from 30 to 46mm with varying offset. The sleeves come in variable size and geometry. The stem choice in revision surgery is based on the Scoot Diamond Classification. Type 1 (this is going to be easy) is a primary stem. Type 2 (this is going to be difficult) implies diaphyseal bone loss and will require a long stem. Type 3 (Oh My God), implies more than 70mm of completely missing proximal femur and will require a
Metaphyseal bone loss is common with revision total knee arthroplasty (TKA). The causes of bone loss include: osteolysis, loosening, infection, iatrogenic or a combination. Small defects can be treated with screws and cement, bone graft, and non-porous metal wedges or blocks. Large defects can be treated with bulk
Background. Despite promising results have shown by osteogenic cell-based demineralized bone matrix composites, they need to be optimized for grafts that act as structural frameworks in load-bearing defects. The purpose of this experiment is to determine the effect of bone marrow mesenchymal stem cells seeding on partially demineralized laser-perforated
The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised knee. Topics covered will include: (1) Exposure in the multiply operated knee (when to use quad snip, tibial tubercle osteotomy, other techniques); (2) Implant removal: Tips for removing stemmed implants; (3) Management of bone loss in multiply operated knees (metal cones/sleeves vs.
Introduction. Acetabular revision surgery is challenging due to severe bone defects. Burch-Schneider anti-protrusion cages (BS cage: Zimmer-Biomet) is one of the options for acetabular revision, however higher dislocation rate was reported. A computed tomography (CT)-based navigation system indicates us the planned direction for implantation of a cemented acetabular cup during surgery. A large diameter femoral head is also expected to reduce the dislocation rate. The purpose of this study is to investigate short-term results of BS cage in acetabular revision surgery combined with the CT-based navigation system and the use of large diameter femoral head. Methods. Sixteen hips of fifteen patients who underwent revision THA using allografts and BS cage between September 2013 and December 2017 were included in this study with the follow-up of 2.7 (0.1–5.0) years. There were 12 women and three men with a mean age of 78.6 years (range, 59–61 years). The cause of acetabular revision was aseptic loosening in all hips. The failed acetabular cup was carefully removed, and acetabular bone defect was graded using the Paprosky classification.
The treatment of extensive bone loss and massive acetabular defects is a challenging procedure, especially in cases with concomitant pelvic discontinuity (PD). Pelvic discontinuity describes the separation of the ilium proximally from the ischio-pubic region distally. The appropriate treatment strategy is to restore a stable continuity between the ischium and the ilium to reconstruct the anatomical hip center. Several treatment options such as antiprotrusio cages, metal augments, reconstruction cages with screw fixation,
The treatment of extensive bone loss and massive acetabular defects is a challenging procedure, especially the concomitant pelvic discontinuity (PD) can be compounded by several challenges and pitfalls. The appropriate treatment strategy is to restore a stable continuity between the ischium and the ilium and to reconstruct the anatomical hip center. Antiprotrusio cages, metal augments, reconstruction cages with screw fixation,