Management Bone Defects

AORI / Andersen Orthopedic Research Institute

 

T Tibial  F Femoral

 

1.  Contained Metaphyseal Defect

 

2.  Damaged Metaphyseal

A.  One Condyle

B.  Both Condyles

 

3.  Deficient Metaphysis +/- collaterals +/- extensor mechanism

 

1.  Contained Metaphyseal defect 

 

Revision TKR AORI Tibia Type 1 APRevision TKR AORI Tibia Type 1 Lateral

 

Management

 

A.  Bone graft defects

 

B.  Standard +/- Revision TKR

 

Revision TKR Type 1 DefectRevision TKR Type 1 Defect Lateral

 

2.  Damaged Metaphysis

 

A One condyle

 

B Both

 

Revision TKR AORI Tibia Type 2 B APRevision TKR AORI Tibial Type 2 B Lateral

 

Revision TKR Tibial Lysis 2BRevision TKR Damaged Tibial Metaphysis

 

Management

 

A.  Cement < 1cm

 

Revision TKR Bone Defect Cement APRevision TKR Bone Defect Cement Lateral.jpg

 

B.  Augments < 2cm

 

Revision TKR Tibial AugmentsRevision TKR Augments

 

C.  Bone graft

 

3.  Deficient Metaphysis +/- collaterals / quads

 

Revision TKR Deficient Femoral Metaphysis

 

Revision TKR Deficient Metaphysis APRevision TKR Deficient Metaphysis Lateral

 

Management

 

A.  Bulk structural allograft

- femoral head

 

Engh et al JBJS Am 2007

- bulk structure allograft in the tibia in 46 patients followed for 8 years

- 2 deep infections

- average knee society scores 84

- no graft collapse or loosening

 

B.  Tantalum cones metaphyseal filling / Trabecular metal

 

Revision TKR Tantalum APRevision TKR Tantalum Lateral

 

Meneghini et al JBJS Am 2009

- tantalum porous tibial implant in 15 pateints followed average 3 years

- AORI type 3 and type 2B

- knee society score average 85

- all had evidence osteointegration, no loosening

 

Howard et al JBJS Am 2011

- femoral tantalum components in 24 knees followed for averag 3 years

- knee society score average 81

- all well fixed with no complications

 

C.  Mesh + impaction bone grafting

 

D.  Tumour prosthesis / Custom implants

 

Revision TKR Tumour ImplantRevision TKR Tumour