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The Journal of Bone and Joint Surgery (American) 85:S52-S57 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Strategies of Stem Fixation and the Role of Supplemental Bone Graft in Revision Total Knee Arthroplasty

Charles L. Nelson, MD, Jess H. Lonner, MD, James A. Rand, MD and Paul A. Lotke, MD

Corresponding author: Paul A. Lotke, MD
Department of Orthopaedic Surgery, University of Pennsylvania, Silverstein Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. E-mail address: paul.lotke@uphs.upenn.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Osteonics, Zimmer, DePuy). In addition, a commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available to our subscribers at no extra charge on the JBJS web site (www.jbjs.org), for a limited time. The same material is available for purchase from the Video Journal of Orthopaedics (www.vjortho.com; telephone: 805-962-3410).

The first 150 words of the full text of this article appear below.


   Introduction
 
Bone loss is commonly encountered at the time of revision total knee arthroplasty because of loosening of the implant, osteolysis, infection, or difficulty with removal of the original implant. Regardless of the etiology of the bone loss, its location and magnitude may compromise adequate fixation, alignment, and ligamentous stability of the revision prosthesis.

In the setting of bone stock deficiency, or when an implant with a constrained articulation is used, it is prudent to use a longer stem to effect stress transition that protects weak or newly grafted proximal bone 1. Successful stabilization of the implant construct can be achieved with a variety of fixation strategies: cementing the condylar surfaces of the implant while using a cementless press-fit stem 2,3, fixation of the entire construct without cement 4, or fixation of the entire construct with cement. All have been used with success 5-7.

Because patterns of bone loss can vary . . . [Full Text of this Article]


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