Orlando Medical Center, Orlando, FL, USA.
J Am Acad Orthop Surg. 2011 Jun;19(6):311-8. doi: 10.5435/00124635-201106000-00001.
The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durable, stable, well-functioning revision TKA include bony deficiency, periarticular osteopenia, deformity, and soft-tissue imbalance. Defect management often requires the use of stems, cement, metal augmentation, or allograft. Recently, there has been interest in obtaining fixation in the metaphyseal region in an attempt to improve construct stability while managing bony deficiency. Often, the metaphyseal bone is well vascularized, which provides an opportunity for additional fixation with cement, allograft, trabecular metal cones, or stepped porous-coated sleeves. Multiple series have documented good survivorship at short-term follow-up with trabecular metal cones and porous-coated sleeves. These newer technologies offer biologic fixation and are useful for treating bony defects that are not easily managed with other methods. Long-term studies are needed to determine the durability of these constructs. Concerns persist regarding stress shielding and difficulty of removal. Familiarity with the rationale and strategies for metaphyseal fixation in revision TKA is a valuable addition to the armamentarium of the revision surgeon.
需要进行翻修全膝关节置换术 (TKA) 的情况正在增加。实现持久、稳定、功能良好的翻修 TKA 面临的挑战包括骨缺损、关节周围骨质疏松症、畸形和软组织失衡。缺陷管理通常需要使用柄、水泥、金属增强物或同种异体移植物。最近，人们对在干骺端区域获得固定以试图在管理骨缺损的同时提高结构稳定性产生了兴趣。通常，干骺端骨具有良好的血供，这为使用水泥、同种异体移植物、小梁金属锥体或阶梯状多孔涂层袖套进行额外固定提供了机会。多个系列的短期随访研究表明，小梁金属锥体和多孔涂层袖套具有良好的存活率。这些新技术提供了生物固定，对于治疗其他方法难以处理的骨缺损非常有用。需要进行长期研究来确定这些结构的耐用性。人们仍然担心应力屏蔽和难以取出的问题。熟悉翻修 TKA 中干骺端固定的原理和策略是翻修外科医生的宝贵工具。
