Custom Made Implant in Revision Knee Arthroplasty with AORI 3 Bone Defect: а Case Report

Background. Replacement of extensive bone defects during revision knee arthroplasty (RKA) is a certain problem. The development of additive technologies allows us to produce an individual titanium augment to restore the lost bone tissue. The aim of the study is to show the possibility of replacing extensive tibia defects with an custom made augment during revision knee artroplasty. Case presentation. The patient is 66 years old. At the age of 58, due to secondary knee osteoarthritis in 2 years interval, the patient underwent total knee arthroplasty: left in 2012, right in 2014. Subsequently, several revision interventions were required for early periprosthetic infection of the right knee joint. From 2015 to 2018, due to the infection remission, the function of the right knee joint was satisfactory. In 2018, the patient admitted to our clinic with the periprosthetic infection relapse. Due to the previous treatment, the patient had type 3 bone defect according to the AORI classification. A two-stage revision knee arthroplasty was performed. To compensate the extensive tibial defect, the individual tibial implant was manufactured using additive technologies, and a semiconstrained endoprosthesis was implanted. There was no relapse of infection during the observation. There is deficit of active extension, there are no radiological signs of the implant instability. Conclusion. In our case, we were able to achieve satisfactory results in patient with a complex anamnesis and extensive bone defects. The use of individual implant helped to avoid arthrodesis, preserve the weight-bearing of the lower limb and articulation in the knee joint. The use of implants made using 3D technologies is a promising solution for compensating defects of types 2B and 3 according to the AORI classification.

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Unprecedented tibial bone lengthening of 33.5 cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03950-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Abdulnassir Ali ◽

Ying Ren ◽

Chun-Hao Zhou ◽

Jia Fang ◽

Cheng-He Qin

Keyword(s):

Bone Defect ◽

Distraction Osteogenesis ◽

Chronic Osteomyelitis ◽

Weight Bearing ◽

Lower Leg ◽

Bone Lengthening ◽

Case Presentation ◽

Tibial Length ◽

Tibial Bone ◽

The Right

Abstract Background We present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function. Case presentation A 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient’s right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia. Conclusion Upon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.

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Use of a trabecular metal cone made of tantalum, to treat bone defects during revision knee arthroplasty

Revista Brasileira de Ortopedia (English Edition) ◽

10.1016/j.rboe.2014.03.009 ◽

2014 ◽

Vol 49 (3) ◽

pp. 245-251 ◽

Cited By ~ 1

Author(s):

Alan de Paula Mozella ◽

Ricardo Reiniger Olivero ◽

Hugo Alexandre ◽

Araújo Barros Cobra

Keyword(s):

Knee Arthroplasty ◽

Bone Defects ◽

Trabecular Metal ◽

Revision Knee Arthroplasty

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KNEE JOINT LINE IDENTIFICATION DURING REVISION KNEE ARTHROPLASTY

10.1055/s-0040-1717476 ◽

2020 ◽

Author(s):

M Kozadaev ◽

M Girkalo ◽

A Derevyanov ◽

A Mandrov ◽

A Kauts

Keyword(s):

Knee Joint ◽

Knee Arthroplasty ◽

Joint Line ◽

Revision Knee Arthroplasty ◽

Line Identification

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Numerical Study of Prosthetic Knee Replacement Using Finite Element Analysis

Journal of Biomimetics Biomaterials and Biomedical Engineering ◽

10.4028/www.scientific.net/jbbbe.44.9 ◽

2020 ◽

Vol 44 ◽

pp. 9-26

Author(s):

Theddeus Tochukwu Akano

Keyword(s):

Finite Element ◽

Knee Joint ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Numerical Study ◽

Knee Prosthesis ◽

Weight Bearing ◽

Experimental Information ◽

Comsol Multiphysics ◽

Element Analysis

The knee at times undergoes a surgical process to substitute the weight-bearing surfaces of the knee joint. This procedure relieves the pain and disability around the knee joint. This research paper studied the knee arthroplasty, also referred to as knee replacement. This work was aided with computer vision for visual and accuracy. Autodesk fusion 360 and the stl files were used to generate cemented, posterior stabilised knee prosthesis and imported into the COMSOL Multiphysics software. Then, the three-dimensional models of the total knee arthroplasty (TKA) prosthetic structure are produced. The prosthetic components are modelled as linear isotropic elastic materials. Finite element (FE) simulations using COMSOL Multiphysics on a CAD model of a knee are effectuated to show the effect of several loads and strains on the knee. FE analysis of the model indicates that the orthotropic model depicts a more realistic stress distribution of the knee as it reveals the detailed anatomy of the entire knee structure. The computational results of this work displayed a fair agreement with experimental information from the literature.

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Extreme bone lengthening by bone transport with a unifocal tibial corticotomy: a case report

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2927-z ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Hongjie Wen ◽

Huagang Yang ◽

Yongqing Xu

Keyword(s):

Bone Defect ◽

External Fixator ◽

Bone Repair ◽

Bone Defects ◽

Bone Transport ◽

External Fixators ◽

Bone Lengthening ◽

Fracture Nonunion ◽

Defect Repair ◽

The Right

Abstract Background Bone transport is used for the treatment of extensive limb bone defects. The application of ring or unilateral external fixators combined with single or double corticotomy are well documented; however, there are few cases adopting a single corticotomy to repair bone defects > 24 cm. Case presentation The present case study describes an 18-year-old male, who was involved in a traffic accident and was diagnosed with open fracture of the right tibia. The patient received emergency surgery in a local hospital and was transferred to The Second People’s Hospital of Yunnan for further treatment 3 months later. The patient was diagnosed with fracture nonunion and infection following admission. Complete debridement was performed three times to control the infection. The infection was resolved after 26 days and the 24.5 cm massive tibia defect remained the biggest challenge. The bone transport technique involving a unilateral external fixator and single corticotomy was employed to treat the bone defect. Docking site union was achieved and bone consolidation was complete 40 months after corticotomy. The external fixator was subsequently removed. The bone healing index was 1.6 months/cm. The Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) revealed a good functional and bone repair result. Similarly, Knee Society Score (KSS) yielded good result and the The Lower Extremity Functional Scale (LEFS) was 65. A total of 45 months after injury, the patient was able to walk painlessly without ambulatory assistive devices and resumed daily activities successfully. Eighteen months after the bone and soft tissue wound have healed, the SF-36 score was 86, and the LEFS was 70. Conclusion To the best of the authors’ knowledge, the present study described the longest bone defect repair performed using bone transport with single level corticotomy.

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Poor Outcome of Above-Knee Amputation after Septic Failure of Revision Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1716416 ◽

2020 ◽

Author(s):

Sabrina Böhle ◽

Sebastian Rohe ◽

Julia Kirschberg ◽

Olaf Brinkmann ◽

Jörn Seeger ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Arthroplasty ◽

Periprosthetic Infection ◽

Short Form ◽

Joint Infection ◽

Treatment Strategies ◽

Primary Total Knee Arthroplasty ◽

Knee Amputation ◽

Total Knee

AbstractPersistent periprosthetic infection following total knee arthroplasty is one of the most dreaded complications of orthopaedic surgery. Treatment strategies include arthrodesis of the knee joint, stable fistula, long-lasting antibiotic therapy, or above-knee amputation. The advantage of amputation in comparison to other treatment options is the possible cure of infection, because the source of infection is removed and no foreign material left in situ. The aim of the study is to examine whether a septic amputation of the femur in case of persistent periprosthetic infection at the knee joint leads to the healing of the patient. Moreover, the physical and mental state should be evaluated. All patients with above-knee amputation because of periprosthetic joint infection after primary total knee arthroplasty between 2016 and 2018 were included in this retrospective study. A questionnaire with the clinical scores visual analog scale, modified Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Survey has been designed. In addition, all characteristics and perioperative data were documented. Eleven patients were included in the study. One patient died after above-knee amputation; all other patients live with a marked impairment of quality of life but with absence of the infection of the leg. Two out of ten are able to walk regularly with an exoprosthesis with forearm crutches, 50% are in a wheelchair, while 30% are bedridden. Patients with above-knee amputation after persistent periprosthetic infections were free of infection and without signs of inflammation. However, this is associated with worse mobility and high mortality rate.

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Impaction bone grafting for the reconstruction of large bone defects in revision knee arthroplasty

Operative Orthopädie und Traumatologie ◽

10.1007/s00064-014-0330-3 ◽

2015 ◽

Vol 27 (1) ◽

pp. 35-46 ◽

Cited By ~ 8

Author(s):

M. Rudert ◽

B.M. Holzapfel ◽

E. von Rottkay ◽

D.E. Holzapfel ◽

U. Noeth

Keyword(s):

Knee Arthroplasty ◽

Bone Grafting ◽

Bone Defects ◽

Impaction Bone Grafting ◽

Revision Knee Arthroplasty ◽

Large Bone ◽

Large Bone Defects

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Individual Revision Knee Arthroplasty Is a Safe Limb Salvage Procedure

Journal of Personalized Medicine ◽

10.3390/jpm11060572 ◽

2021 ◽

Vol 11 (6) ◽

pp. 572

Author(s):

Peter Savov ◽

Lars-Rene Tuecking ◽

Henning Windhagen ◽

Max Ettinger

Keyword(s):

Range Of Motion ◽

Knee Arthroplasty ◽

Case Series ◽

Bone Defects ◽

Safe Procedure ◽

Salvage Procedure ◽

Two Stage ◽

Post Surgery ◽

Custom Made ◽

The Mean

Introduction: Revision total knee arthroplasty after multiple pre-surgeries is challenging. Due to severe bone defects, standard implants for metaphyseal and diaphyseal anchoring may no longer be suitable. The primary aim of this case series is to evaluate the early complication rate for individual knee implants with custom-made cones and stems after two-stage revision with severe bone defects. Methods: Ten patients who were treated with custom-made 3D-printed knee revision implants were included. Inclusion criteria were a two-stage revision due to late-onset or chronic periprosthetic joint infection as well as aseptic loosening. All severe bone defects were AORI type III. All procedure-related complications were evaluated. Postoperative range of motion after one year was measured. The time between the two surgeries was evaluated. Results: The mean follow-up was 21 months (range: 12–40). The mean time between the two-stage surgeries was 71.6 days. No fractures were observed intra- and postoperatively. Two patients were revised without changing metal components due to persistent hematoma (three weeks post-surgery) and persistent PJI (three months post-surgery). The mean passive postoperative range of motion was 92° (range: 80–110°). Conclusions: Individual custom-made implants for rTKA provide a safe procedure for patients with huge bone defects after several pre-surgeries. If standard knee systems with standard cones or sleeves are not suitable anymore, custom-made treatment offers the patient the last option for limb preservation. However, this is associated with increased costs.

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Influence of Patella thickness on Patellofemoral pressure in total knee Arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04175-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hidenori Tanikawa ◽

Mitsunori Tada ◽

Ryo Ogawa ◽

Kengo Harato ◽

Yasuo Niki ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Patellofemoral Joint ◽

Joint Function ◽

Custom Made ◽

Total Knee ◽

Patellar Thickness ◽

Patellofemoral Pressure

Abstract Background Patellofemoral complications are one of the major issues after total knee arthroplasty (TKA). Excessive patellofemoral joint pressure is associated with complications after TKA surgery, and the amount of patellar osteotomy has a direct effect on patellofemoral joint pressure. The purpose of this study was to evaluate the influence of patella thickness on patellofemoral pressure in TKA. Methods Five freshly frozen cadavers were operated with a custom-made Stryker posterior stabilizing type knee joint prosthesis. Patellofemoral joint pressure was measured using a pressure sensor, with the knee joint flexed from 90 to 110 degrees, and with patellar thickness of − 2 mm to + 4 mm. Results Increasing or decreasing patellar thickness significantly increased or decreased patellofemoral pressure. Regarding knee flexion angle, patellofemoral pressure increased with increasing patellar thickness at all flexion angles, but the pressure increase was greatest at 90 degrees of knee flexion and smallest at 110 degrees. Conclusions The amount of patellar osteotomy influences the patellofemoral pressure. Surgeons should avoid increasing patella thickness, since the resulting increased patellofemoral pressure may reduce knee joint function.

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