Stem Fixation in Revision Total Knee Arthroplasty: Indications, Stem Dimensions, and Fixation Methods
5
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Although stems improve initial mechanical stability in revision total knee arthroplasty (TKA), ideal indications, proper lengths and diameters, and appropriate fixation methods remain controversial. The topics of the present article include the indications, selection of lengths and diameters, and fixation methods of stems in revision TKA. The use of a stem in revision TKA can protect the juxtaarticular bone. A stem cannot be a substitute for optimal component fixation; it plays an adjunctive role in transferring the loads from the compromised metaphysis to the stronger diaphysis. Proper bone surface preparation and appropriate use of the stem based on a great store of knowledge are required to support the stemmed components effectively in revision TKA. The balance between overshielding and overloading the juxtaarticular bone would provide excellent structural protection. The stem length and diameter should be tailored according to patients’ anatomical characteristics and determined fixation strategy. There are two traditional methods of stem fixation including the total cementation technique and the hybrid technique with a cementless pressfit stem. Selection of a cementation technique should be based on thorough consideration of advantages and disadvantages of each technique.
Abstract
Although stems improve initial mechanical stability in revision total knee arthroplasty (TKA), ideal indications, proper lengths and diameters, and appropriate fixation methods remain controversial. The topics of the present article include the indications, selection of lengths and diameters, and fixation methods of stems in revision TKA. The use of a stem in revision TKA can protect the juxtaarticular bone. A stem cannot be a substitute for optimal component fixation; it plays an adjunctive role in transferring the loads from the compromised metaphysis to the stronger diaphysis. Proper bone surface preparation and appropriate use of the stem based on a great store of knowledge are required to support the stemmed components effectively in revision TKA. The balance between overshielding and overloading the juxtaarticular bone would provide excellent structural protection. The stem length and diameter should be tailored according to patients’ anatomical characteristics and determined fixation strategy. There are two traditional methods of stem fixation including the total cementation technique and the hybrid technique with a cementless pressfit stem. Selection of a cementation technique should be based on thorough consideration of advantages and disadvantages of each technique.
참고문헌 (29)
- Scott CE, "The role of the design of tibial components and stems in knee replacement", J Bone Joint Surg Br, 94, pp.1009~1015 (2012)
- Murray PB, "Cemented long-stem revision total knee arthroplasty", Clin Orthop Relat Res, (309), pp.116~123 (1994)
- Weeden SH, "The adult knee", pp.1439~1445 (2003), Lippincott Williams and Wilkins
- Bottner F, "Hybrid component fixation in revision total knee arthroplasty", Clin Orthop Relat Res, 446, pp.127~131 (2006)[DOI]
- Crawford DA, "Results of a modular revision system in total knee arthroplasty", J Arthroplasty, 32, pp.2792~2798 (2017)[DOI]
- Brand MG, "Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency", Clin Orthop Relat Res, (248), pp.71~79 (1989)
- Daines BK, "Management of bone defects in revision total knee arthroplasty", Instr Course Lect, 62, pp.341~348 (2013)
- Engh GA, "Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction", Instr Course Lect, 48, pp.167~175 (1999)
- Anderson JA, "Constrained condylar knee without stem extensions for difficult primary total knee arthroplasty", J Knee Surg, 20, pp.195~198 (2007)
- Sabatini L, "Condylar constrained system in primary total knee replacement: our experience and literature review", Ann Transl Med, 5, pp.135~ (2017)[DOI]
- Rorabeck CH, "Classification of periprosthetic fractures complicating total knee arthroplasty", Orthop Clin North Am, 30, pp.209~214 (1999)[DOI]
- Felix NA, "Periprosthetic fractures of the tibia associated with total knee arthroplasty", Clin Orthop Relat Res, (345), pp.113~124 (1997)
- Hicks CA, "The anatomy of the tibial intramedullary canal", Clin Orthop Relat Res, (321), pp.111~116 (1995)
- Tang Q, "The offset of the tibial shaft from the tibial plateau in Chinese people", J Bone Joint Surg Am, 92, pp.1981~1987 (2010)[DOI]
- Conlisk N, "The influence of stem length and fixation on initial femoral component stability in revision total knee replacement", Bone Joint Res, 1, pp.281~288 (2012)[DOI]
- Jazrawi LM, "The effect of stem modularity and mode of fixation on tibial component stability in revision total knee arthroplasty", J Arthroplasty, 16, pp.759~767 (2001)[DOI]
- Wood GC, "Results of press-fit stems in revision knee arthroplasties", Clin Orthop Relat Res, 467, pp.810~817 (2009)[DOI]
- El-Zayat BF, "Fixation techniques and stem dimensions in hinged total knee arthroplasty: a finite element study", Arch Orthop Trauma Surg, 136, pp.1741~1752 (2016)[DOI]
- Gililland JM, "Clinical & radiographic outcomes of cemented vs. diaphyseal engaging cementless stems in aseptic revision TKA", J Arthroplasty, 29(9 Suppl), pp.224~228 (2014)[DOI]
- Patel AR, "Stem length in revision total knee arthroplasty", Curr Rev Musculoskelet Med, 8, pp.407~412 (2015)[DOI]
- Fleischman AN, "Optimizing mechanical alignment with modular stems in revision TKA", J Arthroplasty, 32(9S), pp.S209~S213 (2017)[DOI]
- Fleischman AN, "Effect of stem size and fixation method on mechanical failure after revision total knee arthroplasty", J Arthroplasty, 32(9S), pp.S202~S208 (2017)[DOI]
- Parsley BS, "Mechanical alignment of tibial stems in revision total knee arthroplasty", J Arthroplasty, 18(7 Suppl 1), pp.33~36 (2003)[DOI]
- Gobba MS, "Tibial stems in revision total knee arthroplasty: is there an anatomic conflict?", J Arthroplasty, 30(9 Suppl), pp.86~89 (2015)
- Pfeifer R, "The biology of intramedullary reaming", Injury, 41(Suppl 2), pp.S4~S8 (2010)[DOI]
- Wang C, "Fixation of stem in revision of total knee arthroplasty: cemented versus cementless-a meta-analysis", Knee Surg Sports Traumatol Arthrosc, 24, pp.3200~3211 (2016)[DOI]
- Heesterbeek PJ, "No Difference in implant micromotion between hybrid fixation and fully cemented revision total knee arthroplasty: a randomized controlled trial with radiostereometric analysis of patients with mild-to-moderate bone loss", J Bone Joint Surg Am, 98, pp.1359~1369 (2016)[DOI]
- Edwards PK, "Are cementless stems more durable than cemented stems in two-stage revisions of infected total knee arthroplasties?", Clin Orthop Relat Res, 472, pp.206~211 (2014)[DOI]
- Foruria X, "Does the tibia component design affect the need for offset stems in revision total knee arthroplasty", Arch Orthop Trauma Surg, 137, pp.853~860 (2017)[DOI]