Revision Total Knee Arthroplasty: From Minimal to Severe Bone Loss

Management of bone loss in the revision total knee arthroplasty (TKA) setting is determined by the location and magnitude of bone loss, ligament integrity, surgeon experience, and patient factors. Smaller, contained defects are reliably managed with bone graft, cement augmented with screw fixation, or modular augments. Large metaphyseal defects require more extensive reconstruction such as impaction bone grafting with or without mesh augmentation, prosthetic augmentation, use of bulk structural allografts, or use of metaphyseal cones or sleeves. While each technique has advantages and disadvantages, the optimal method for reconstruction of large metaphyseal bone defects during revision TKA is not clearly established. The use of allograft has declined in recent years due to an increased failure rate with long-term follow-up and with the introduction of porous metal augments that emphasize biological metaphyseal fixation.