Mozella Alan de Paula, Cobra Hugo Alexandre de Araújo Barros
Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.
Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil.
Rev Bras Ortop (Sao Paulo). 2021 Apr;56(2):138-146. doi: 10.1055/s-0040-1713392. Epub 2020 Sep 25.
The increase in the number of revision total knee arthroplasty surgeries has been observed in recent years, worldwide, for several causes. In the United States, a 601% increase in the number of total knee arthroplasties, between 2005 and 2030, is estimated. Among the enormous challenges of this complex surgery, the adequate treatment of bone defects is essential to obtain satisfactory and lasting results. The adequate treatment of bone defects aims to build a stable and lasting support platform for the implantation of the definitive prosthetic components and, if possible, with the reconstruction of bone stock. Concomitantly, it allows the correct alignment of the prosthetic and limb components, as well as restoring the height of the joint interline and, thus, restoring the tension of soft parts and load distribution to the host bone, generating a joint reconstruction with good function, stable, and painless. There are several options for the management of these bone defects, among them: bone cement with or without reinforcement with screws, modular metallic augmentations, impacted bone graft, structural homologous graft and, more recently, metal metaphyseal cones, and metaphyseal sleeves. The objective of the present article was to gather classic information and innovations about the main aspects related to the treatment of bone defects during revision surgeries for total knee arthroplasty.
近年来，在全球范围内，由于多种原因，全膝关节置换翻修手术的数量有所增加。在美国，预计2005年至2030年间全膝关节置换手术的数量将增长601%。在这种复杂手术面临的诸多挑战中，充分治疗骨缺损对于获得满意且持久的效果至关重要。骨缺损的充分治疗旨在为植入最终假体组件构建一个稳定且持久的支撑平台，并尽可能重建骨量。同时，它能使假体和肢体组件正确对齐，恢复关节间隙高度，从而恢复软组织张力并将负荷分布到宿主骨，实现功能良好、稳定且无痛的关节重建。处理这些骨缺损有多种选择，包括：带或不带螺钉加强的骨水泥、模块化金属增强物、打压植骨、结构性同种异体骨移植，以及最近出现的金属干骺端锥体和干骺端套筒。本文的目的是收集有关全膝关节置换翻修手术中骨缺损治疗主要方面的经典信息和创新内容。
