Techniques for Managing Severe Bone Loss in Revision TKA

    Massive femoral and tibial bone loss remains a challenge for surgeons performing revision total knee arthroplasty.

    Multiple options are available for managing these defects, with the optimum choice depending on the extent of the defect. At ICJR’s annual Winter Hip & Knee Course, Matthew P. Abdel, MD, broke it down this way:

    Rebuilding the defect. This is for small Type 1 defects, typically 5 mm or less, and it is usually accomplished with structural or non-structural allografts.

    Reinforcing the defect. Small, contained cavitary defects, also Type 1 defects of 5 mm or less, can be reinforced with cement.

    Augmenting the defect. Larger defects can be managed with prostheses – sleeves and cones – to provide metaphyseal fixation. These prostheses address both bone loss and the need for biologic fixation in Type 2a, 2b, and 3 defects.

    Dr. Abdel prefers to use sleeves with Type 2a bone loss and cones with Type 2b and 3 defects. Sleeves, he said, are linked to a specific device, while cones can be used with any prosthesis and are typically used with more severe bone defects.

    Click the image above to watch Dr. Abdel’s presentation, which includes intraoperative videos on his technique and rationale for the use of tibial and femoral cones. He also highlights 2 studies on metaphyseal cones.

    Disclosures: Dr. Abdel has disclosed that he receives royalties from and is a paid speaker for Stryker.