Jabbal Monu, Simpson A Hamish Rw, Walmsley Phil
Orthop Rev (Pavia). 2023 May 24;15:75359. doi: 10.52965/001c.75359. eCollection 2023.
Primary total knee arthroplasty (TKA) is an effective treatment which is increasing in use for both elderly and younger patients. With the overall increasing life span of the general population, the rate of revision TKA is projected to increase significantly over the coming decades. Analyses from the national joint registry of England and Wales support this prediction with an increase in primary TKA of 117% and an increase in revision TKA of 332% being forecast by 2030. Bone loss presents a challenge in revision TKA so an understanding of the aetiology and principles behind this is essential for the surgeon undertaking revision. The purpose of this article is to review the causes of bone loss in revision TKA, discuss the mechanisms of each cause and discuss the possible treatment options.
The Anderson Orthopaedic Research Institute (AORI) classification and zonal classification of bone loss are commonly used in assessing bone loss in pre-operative planning and will be used in this review. The recent literature was searched to find advantages and limitations of each commonly used method to address bone loss at revision TKA. Studies with the highest number or patients and longest follow-up period were selected as significant. Search terms were: "aetiology of bone loss", "revision total knee arthroplasty", "management of bone loss".
Methods for managing bone loss have traditionally been cement augmentation, impaction bone grafting, bulk structural bone graft and stemmed implants with metal augments. No single technique was found to be superior. Megaprostheses have a role as a salvage procedure when the bone loss is deemed to be too significant for reconstruction. Metaphyseal cones and sleeves are a newer treatments with promising medium to long term outcomes.
Bone loss encountered at revision TKA presents a significant challenge. No single technique currently has clear superiority treatment should be based on a sound understanding of the underlying principles.
初次全膝关节置换术（TKA）是一种有效的治疗方法，在老年和年轻患者中的应用都在增加。随着普通人群总体寿命的不断延长，预计在未来几十年中，翻修TKA的发生率将显著上升。英格兰和威尔士国家关节登记处的分析支持了这一预测，预计到2030年，初次TKA将增加117%，翻修TKA将增加332%。骨丢失在翻修TKA中是一个挑战，因此了解其病因和背后的原则对于进行翻修手术的外科医生至关重要。本文的目的是回顾翻修TKA中骨丢失的原因，讨论每种原因的机制，并探讨可能的治疗选择。
安德森骨科研究所（AORI）分类和骨丢失的分区分类在术前规划中评估骨丢失时常用，本综述将采用这些分类。检索近期文献，以找出每种常用方法在处理翻修TKA骨丢失方面的优缺点。选择患者数量最多和随访期最长的研究作为有意义的研究。检索词为：“骨丢失的病因”、“翻修全膝关节置换术”、“骨丢失的处理”。
传统上，处理骨丢失的方法包括骨水泥增强、打压植骨、大块结构性骨移植和带有金属增强物的带柄植入物。没有发现单一技术具有优越性。当骨丢失被认为对重建来说过于严重时，巨型假体可作为一种挽救手术发挥作用。干骺端锥体和套筒是一种较新的治疗方法，具有良好的中长期效果。
翻修TKA时遇到的骨丢失是一个重大挑战。目前没有单一技术具有明显优势，治疗应基于对基本原理的充分理解。
