Bone loss management: A potpourri of options

Abstract

Bone loss encountered during revision TKA can make proper alignment and fixation a challenge. Causes for bone loss in revision TKA include implant loosening, osteolysis, and iatrogenic from implant removal. Reproducible clinical success can be achieved if metaphyseal fixation is achieved [1]. In the absence of cancellous bone for cement fixation, metaphyseal augments placed without cement have shown promise in achieving fixation. First generation augments were modular solid titanium sleeves attached to a taper at the base of the core implant. The introduction of tantalum with its favorable mechanical qualities markedly increased the utility and utilization of metaphyseal augments, with several encouraging reports. These are either large augments where the bone is prepared with a burr, or later, small cones placed with a cannulated broaching technique. Both have addressed practical challenges, the first being limited by the reproducibility of bone preparation, and the second with excellent reproducibility of bone preparation but limited inner diameters. More recent highly porous titanium surfaces have further broadened the choices by allowing larger inner diameters to the cones, which allow the use of offset stems.This article aims to review the senior author's experience in managing bone loss in the revision TKA setting.