PMID: 9553582Apr 29, 1998Paper

Results of revision total knee arthroplasty in the face of significant bone deficiency

The Orthopedic Clinics of North America
C H Rorabeck, P N Smith

Abstract

The successful approach to the failed knee with bone deficiency is dependent upon thorough planning prior to surgery in order to have the resources available in terms of adequate bone allograft and suitable revision implants. The approximate size of bone stock deficiency can be calculated from preoperative radiographs and similarly ligamentous incompetence can often be diagnosed clinically prior to surgery. Smaller defects of up to 1 to 1.5 cm in depth and localized in the main to a single side of the tibial plateau or to a single femoral condyle can be dealt with using smaller grafts that may be local autograft or allograft, or modular wedges. Larger tibial defects can be compensated for using conventional revision systems by thicker polyethylene and augmented baseplates, but once the flexion-extension gap reaches approximately 40 mm this is no longer possible and structural graft or customized componentry becomes necessary. Femoral defects larger than about 1 cm that cannot be made up by augments necessitate grafting. The need to use a large proximal tibial allograft also may dictate the operative approach used to expose the joint, especially in the situation of a multiply-operated tight knee. In such cases the use of a quadr...Continue Reading

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Citations

Feb 24, 2011·Operative Orthopädie und Traumatologie·R HubeH O Mayr
Nov 17, 2007·Archives of Orthopaedic and Trauma Surgery·Konstantinos J KazakosIoannis Psillakis
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