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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 8, pp 2559–2566 | Cite as

Comparative assessment of different reconstructive techniques of distal femur in revision total knee arthroplasty

  • A. Completo
  • F. Fonseca
  • A. Ramos
  • J. Simões
Knee
  • 489 Downloads

Abstract

Purpose

Bone loss is often encountered in revision total knee arthroplasty. In particular, when the cortex of distal femur is breached, the surgical decision on the reconstructive options to be taken is challenging due to the variety of defects and the lack of data from clinical or experimental studies that can support it. The aim of the present work was to test the hypothesis that for an identical defect and bone condition, each reconstructive technique option has a dissimilar stress and stability behaviour, which may be related to differing longevity of the revision procedure.

Methods

Triaxial strain gauges and video extensometer were used to measure distal cortex strains and implant stability in eight reconstructive techniques replicated with synthetic femur under a load of 2030N. To assess the cancellous bone strains, finite element models were developed and validated.

Results

The measured strains showed that the distal cortex is not immune to the different reconstructive techniques, when applied to an identical defect; however, significant differences (P < 0.05) were found only between bone graft and metal augment on the 12-mm larger distal defect. The stem addition improves the stability of all reconstructive techniques; however, significant differences (P = 0.03) were found only on the bone-graft technique.

Conclusions

Cement-fill and metal-augment techniques, applied to the 4-mm smaller defect, are not associated with different structural behaviour, while for the 12-mm larger defect, the metal-augment and bone-graft techniques presented distinct biomechanical effects. These effects, by themselves, may not be sufficient to be associated with a different longevity of the revision procedure among techniques, when the stem is added to the bone-graft technique. These findings, based on independent scientific understanding and advanced prediction tools, can improve the surgical decision-making process, when the peripheral cortex of the distal femur is breached.

Keywords

Revision total knee arthroplasty Modular augments Structural allograft Press-fit stem Experimental strains 

Notes

Acknowledgments

The authors wish to thank: the Programa Operacional Fatores de Competitividade—COMPETE e por Fundos Nacionais através da FCT—Fundação para a ciência e a Tecnologia no âmbito dos projetos FCOMP-01-0124-FEDER-010248, FCOMP-01-0124-FEDER-015143 and FCOMP-01-0124-FEDER-015191.

References

  1. 1.
    Backstein D, Safir O, Gross A (2006) Management of bone loss: structural grafts in revision total knee arthroplasty. Clin Orthop Relat Res 446:104–112CrossRefPubMedGoogle Scholar
  2. 2.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51CrossRefPubMedGoogle Scholar
  3. 3.
    Chen AF, Choi LE, Colman MW, Goodman MA, Crossett LS, Tarkin IS, McGough RL (2013) Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures. J Arthroplasty 28:1580–1584CrossRefPubMedGoogle Scholar
  4. 4.
    Choi K, Goldstein SA (1992) A comparison of the fatigue behavior of human trabecular and cortical bone tissue. J Biomech 25:1371–1381CrossRefPubMedGoogle Scholar
  5. 5.
    Cipolletti GB, Cook FW (1978) Fatigue of bone cement in physiological saline at one Hz. In: Transactions of the 4th annual society for biomaterials, 10th international biomaterials symposium. San Antonio, pp 134–135Google Scholar
  6. 6.
    Completo A, Fonseca F, Simões J, Ramos A, Relvas C (2012) A new press-fit stem concept to reduce the risk of end-of-stem pain at revision TKA: a pre-clinical study. Knee 19:537–542CrossRefPubMedGoogle Scholar
  7. 7.
    Completo A, Duarte R, Fonseca F, Simões JA, Ramos A, Relvas C (2013) Biomechanical evaluation of different reconstructive techniques of proximal tibia in revision total knee arthroplasty: an in vitro and finite element analysis. Clin Biomech 28:291–298CrossRefGoogle Scholar
  8. 8.
    Completo A, Simões J, Fonseca F (2009) Revision total knee arthroplasty: the influence of femoral stems in load sharing and stability. Knee 16:275–279CrossRefPubMedGoogle Scholar
  9. 9.
    Completo A, Fonseca F, Relvas C, Ramos A, Simões J (2011) Improved Stability with intramedullary stem after anterior femoral notching in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:487–494CrossRefPubMedGoogle Scholar
  10. 10.
    Completo A, Rego A, Fonseca F, Ramos A, Relvas C, Simões JA (2010) Biomechanical evaluation of proximal tibia behaviour with the use of femoral stems in revision TKA: an in vitro and finite element analysis. Clin Biomech 25:159–165CrossRefGoogle Scholar
  11. 11.
    Delloye C, Cornu O, Druez V, Barbier O (2007) Bone allografts: What they can offer and what they cannot. J Bone Joint Surg Br 89:574–580CrossRefPubMedGoogle Scholar
  12. 12.
    Dennis DA (1998) Repairing minor bone defects: augmentation and autograft. Orthopedics 21:1036–1038PubMedGoogle Scholar
  13. 13.
    Engh GA, Herzwurm PJ, Parks NL (1997) Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty. J Bone Joint Surg Am 79:1030–1039CrossRefPubMedGoogle Scholar
  14. 14.
    Engh GA, Ammeen DJ (2007) Use of structural allograft in revision total knee arthroplasty in knees with severe tibial bone loss. J Bone Joint Surg Am 89:2640–2647CrossRefPubMedGoogle Scholar
  15. 15.
    Franke KF, Nusem I, Gamboa G, Morgan DA (2013) Outcome of revision total knee arthroplasty with bone allograft in 30 cases. Acta Orthop Belg 79:427–434PubMedGoogle Scholar
  16. 16.
    Frost HM (2003) Bone’s Mechanostat: a 2003 update. Anat Rec A 275:1081–1101CrossRefGoogle Scholar
  17. 17.
    Gardner MP, Chong AC, Pollock AG, Wooley PH (2010) Mechanical evaluation of large-size fourth-generation composite femur and tibia models. Ann Biomed Eng 38:613–620CrossRefPubMedGoogle Scholar
  18. 18.
    Ghazavi M, Stockley I, Yee G, Davis A, Gross AE (1997) Reconstruction of massive bone defects with allograft in revision total knee arthroplasty. J Bone Joint Surg Am 79(17):25Google Scholar
  19. 19.
    Gross TS, Rubin CT (1995) Uniformity of resorptive bone loss induced by disuse. J Orthop Res 13:708–714CrossRefPubMedGoogle Scholar
  20. 20.
    Hanna SA, Aston WJ, de Roeck NJ, Gough-Palmer A, Powles DP (2011) Cementless revision TKA with bone grafting of osseous defects restores bone stock with a low revision rate at 4 to 10 years. Clin Orthop Relat Res 469:3164–3171CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Heiner A (2008) Structural properties of fourth-generation composite femurs and tibias. J Biomech 41:3282–3284CrossRefPubMedGoogle Scholar
  22. 22.
    Hockman DE, Ammeen D, Engh GA (2005) Augments and allografts in revision total knee arthroplasty: usage and outcome using one modular revision prosthesis. J Arthroplasty 20:35–41CrossRefPubMedGoogle Scholar
  23. 23.
    Huiskes R (1993) Mechanical failure in total hip arthroplasty with cement. Curr Orthop 7(239):247Google Scholar
  24. 24.
    Huten D (2013) Femorotibial bone loss during revision total knee arthroplasty. Orthop Traumatol Surg Res 99:22–33CrossRefGoogle Scholar
  25. 25.
    Iosifidis M, Iliopoulos E, Neofytou D, Sakorafas N, Andreou D, Alvanos D, Kyriakidis A (2014) The Rotaglide mobile-bearing total knee arthroplasty: no difference between cemented and hybrid implantation. Knee Surg Sports Traumatol Arthrosc 22:1843–1848CrossRefPubMedGoogle Scholar
  26. 26.
    Lim LA, Trousdale RT, Berry DJ, Hanssen AD (2011) Failure of the stem-condyle junction of a modular femoral stem in revision total knee arthroplasty: a report of five cases. J Arthroplasty 16:128–132CrossRefGoogle Scholar
  27. 27.
    Loughead JM, Malhan K, Mitchell SY, Pinder IM, McCaskie AW, Deehan DJ, Lingard EA (2008) Outcome following knee arthroplasty beyond 15 years. Knee 15:85–90CrossRefPubMedGoogle Scholar
  28. 28.
    Morrison JB (1970) The mechanics of the knee joint in relation to normal walking. J Biomech 3:51–61CrossRefPubMedGoogle Scholar
  29. 29.
    Nazarian DG, Mehta S, Booth RE Jr (2002) A comparison of stemmed and unstemmed components in revision knee arthroplasty. Clin Orthop Relat Res 404:256–262CrossRefGoogle Scholar
  30. 30.
    Panegrossi G, Ceretti M, Papalia M, Casella F, Favetti F, Falez F (2014) Bone loss management in total knee revision surgery. Int Orthop 38:419–427CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Rand JA (1998) Modular augments in revision total knee arthroplasty. Orthop Clin North Am 29:347–353CrossRefPubMedGoogle Scholar
  32. 32.
    Richards CJ, Garbuz DS, Pugh L, Masri BA (2011) Revision total knee arthroplasty: clinical outcome comparison with and without the use of femoral head structural allograft. J Arthroplasty 26:1299–1304CrossRefPubMedGoogle Scholar
  33. 33.
    Saha S, Pal S (1984) Mechanical properties of bone cement: a review. J Biomed Mater Res 18:435–462CrossRefPubMedGoogle Scholar
  34. 34.
    Sheng PY, Konttinen L, Lehto M, Ogino D, Jamsen E, Nevalainen J, Pajamaki J, Halonen P, Konttinen YT (2006) Revision total knee arthroplasty: 1990 through 2002. A review of the Finnish arthroplasty registry. J Bone Joint Surg Am 88:1425–1430PubMedGoogle Scholar
  35. 35.
    Taylor M, Tanner KE (1997) Fatigue failure of cancellous bone: a possible cause of implant migration and loosening. J-Bone-Joint-Surg Br 79:181–182CrossRefPubMedGoogle Scholar
  36. 36.
    Whittaker JP, Dharmarajan R, Toms AD (2008) The management of bone loss in revision total knee replacement. J Bone Joint Surg Br 90:981–987CrossRefPubMedGoogle Scholar
  37. 37.
    Zhang Y, Ahn P, Fitzpatrick D, Heiner A, Poggie R, Brown T (1999) Interfacial frictional behavior: cancellous bone, cortical bone, and a novel porous tantalum biomaterial. J Musculoskelet Res 3:245–251CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  1. 1.Department of Mechanical EngineeringUniversity of AveiroAveiroPortugal
  2. 2.Department of OrthopaedicsCoimbra University HospitalCoimbraPortugal

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