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Bone Loss in Revision Total Knee Arthroplasty: Evaluation and Management

Sheth, Neil P. MD; Bonadio, Marcelo Batista MD; Demange, Marco Kawamura PhD

Journal of the American Academy of Orthopaedic Surgeons: May 2017 - Volume 25 - Issue 5 - p 348–357
doi: 10.5435/JAAOS-D-15-00660
Review Article

With the increasing number of total knee arthroplasty (TKA) procedures being performed annually, the burden of revision surgery is also expected to increase. Addressing bone loss during revision TKA is a considerable challenge that requires proper preoperative evaluation and surgical planning. In addition to an assessment of femoral and tibial bone loss, a systematic approach to the management of bone loss associated with TKA includes careful implant selection, adherence to the general principles of revision TKA, and an understanding of the available reconstruction options. These options include cement with screws, morcellized allograft, bulk structural allograft, modular wedges, block augments, porous metal cones or sleeves, and megaprostheses.

From the Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA (Dr. Sheth), and the Department of Orthopaedic Surgery, Universidade de São Paulo, São Paulo, Brazil (Dr. Bonadio and Dr. Demange).

Dr. Sheth or an immediate family member serves as a paid consultant to Smith & Nephew and Zimmer Biomet. Dr. Demange or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Baxter International, DePuy Synthes, Mundipharma, and Smith & Nephew; and serves as a board member, owner, officer, or committee member of the International Cartilage Repair Society and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine. Neither Dr. Bonadio nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Received November 11, 2015

Received in revised form April 16, 2016

Received in revised form February 24, 2016

Accepted May 27, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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