Lombardi Adolph V, MacDonald Steven J, Lewallen David G, Fehring Thomas K
Instr Course Lect. 2019;68:217-230.
With utilization of both primary and revision total knee arthroplasty projected to increase in coming decades particularly in younger, more active patients, a determination of best surgical practices is vital to meet the burden of demand. Four challenges in surgical techniques for revision total knee arthroplasty include surgical exposure, careful removal of components, bone deficit management, and fixation options. Surgical exposure may be more complicated in patients presenting for revision who have a history of multiple prior surgeries, infection, scar tissue formation, stiffness, ligamentous deficiency, or vascular compromise. Removal of previous implants while preserving bone stock and ligamentous stabilizers requires adequate exposure of interfaces and visualization, and is facilitated with a variety of tools and techniques. Treatment options for management of bone deficits have expanded in recent years to include a wide range of porous metal sleeves, cones, and augments, in addition to the traditional arsenal of screws, cement, bone graft, metallic augments, offset adapters, and stems in various lengths and geometries. Stem fixation may be noncemented, cemented, or hybrid, with the goal of the stems to load share and enhance the mechanical stability of the reconstruction.
预计在未来几十年里，初次全膝关节置换术和翻修全膝关节置换术的使用量都会增加，尤其是在更年轻、活动量更大的患者中，确定最佳手术方法对于应对需求负担至关重要。翻修全膝关节置换术的手术技术面临四个挑战，包括手术显露、仔细取出假体组件、骨缺损处理和固定方式。对于有多次既往手术史、感染、瘢痕组织形成、僵硬、韧带缺损或血管受损的翻修患者，手术显露可能更复杂。在保留骨量和韧带稳定结构的同时取出先前的植入物，需要充分显露界面并进行可视化操作，多种工具和技术有助于实现这一点。近年来，骨缺损处理的治疗选择有所增加，除了传统的螺钉、骨水泥、骨移植、金属垫块、偏移适配器以及各种长度和几何形状的柄等手段外，还包括多种多孔金属套筒、锥体和垫块。柄的固定可以是非骨水泥型、骨水泥型或混合型，其目的是分担负荷并增强重建的机械稳定性。
