Abstract
The best methods to manage tibial bone defects following total knee arthroplasty remain under debate. Different fixation systems exist to help surgeons reconstruct knee osseous bone loss (such as tantalum cones, cement, modular metal augments, autografts, allografts and porous metaphyseal sleeves) However, the effects of the various solutions on the long-term outcome remain unknown. In the present work, a bone remodeling mathematical model was used to predict bone remodeling after total knee arthroplasty (TKA) revision. Five different types of prostheses were analyzed: one with a straight stem; two with offset stems, with and without supplements; and two with sleeves, with and without stems. Alterations in tibia bone density distribution and implant Von Mises stresses were quantified.In all cases, the bone density decreased in the proximal epiphysis and medullary channels, and an increase in bone density was predicted in the diaphysis and around stem tips. The highest bone resorption was predicted for the offset prosthesis without the supplement, and the highest bone formation was computed for the straight stem. The highest Von Mises stress was obtained for the straight tibial stem, and the lowest was observed for the stemless metaphyseal sleeves prosthesis.The computational model predicted different behaviors among the five systems. We were able to demonstrate the importance of choosing an adequate revision system and that in silico models may help surgeons choose patient-specific treatments.
Highlights
The aim of revision knee arthroplasty is to obtain a stable articulation with an acceptable level of pain-free range of motion, by preserving remaining viable bone structures, reconstructing existing bone defects and restoring the joint level [1, 2]
The osseous defects observed in revision total knee arthroplasty (TKA) are challenging to manage and can be underestimated
Autografts and allografts have been successful with small bone defects [3], but in cases of large bone defects, high failure rates were observed with this solution [9]
Summary
The aim of revision knee arthroplasty is to obtain a stable articulation with an acceptable level of pain-free range of motion, by preserving remaining viable bone structures, reconstructing existing bone defects and restoring the joint level [1, 2]. There are different fixation techniques for bone defects of type 2 (defects in the metaphyseal tibial plateau bone) and type 3 (deficient metaphyseal plateau bone) [3] These fixation techniques include diaphyseal stem fixation, metal augments, tantalum cones, custom-made implants, allograft reconstruction, and offset tibial stems. Metaphyseal sleeves and tantalum cones are good alternatives for large bone defects [10, 12]. Most of these procedures have shown promising early outcomes [6, 7, 12,13,14] and mid-term results [15, 16] but the long-term effect of bone resorption of the tibia remains unknown
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