Mancuso Francesco, Beltrame Arianna, Colombo Elia, Miani Enrick, Bassini Fabrizio
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Acta Biomed. 2017 Jun 7;88(2S):98-111. doi: 10.23750/abm.v88i2-S.6520.
Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions.
Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates.
Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host.
The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors.
翻修全膝关节置换术（TKA）通常因存在骨缺损而变得更加复杂，这些骨缺损可能由假体周围感染、聚乙烯磨损、植入物松动或骨折引起。本研究的主要目的是回顾现有文献，以了解目前处理膝关节翻修术中骨丢失的方法。
评估了有关翻修TKA中骨缺损的英文文献，观察其治疗方法以及临床、放射学结果和失败率方面的结果。
安德森骨科研究所（AORI）分类是最常用的，因为它有助于选择最合适的治疗方法。在翻修膝关节置换术的干骺端骨丢失处理方面有多种选择。对于小的局限性缺损（AORI 1型），可使用带或不带螺钉的骨水泥以及自体或异体粉碎骨。对于非局限性但轻度的缺损（AORI 2A型），应使用金属增强物，而大的非局限性缺损（AORI 2B型和3型）最好用结构性异体骨或金属填充装置（锥体和套筒）处理。建议使用骨水泥型或非骨水泥型带柄组件，以减少植入物与宿主界面处的应力。
在过去几年中，翻修TKA中骨缺损的治疗方法不断发展，在短期/中期随访中提供了不同的选择且效果良好。随着翻修负担的增加，需要更多科学证据来为每位患者确定最佳方法。翻修TKA后的长期临床结果以及植入物存活率仍不尽人意，并且取决于许多因素，包括翻修原因、手术方式、所用植入物类型以及各种患者因素。
