Special Focus Section
139
Wear and Loosening in Total Knee Arthroplasty: A Quick Review James F. Fraser, MD, MPH1
Steven Werner, DO2
David J. Jacofsky, MD3
1 Department of Orthopedics, Banner Good Samaritan Hospital,
Phoenix, Arizona 2 Division of Adult Reconstruction, The CORE Institute, Center for Orthopedic Research and Education, Phoenix, Arizona 3 The CORE Institute, Center for Orthopedic Research and Education, Phoenix, Arizona
Address for correspondence James F. Fraser, MD, MPH, Department of Orthopedics, Banner Good Samaritan Hospital, 1320 N. 10th Street, Suite A, Phoenix, AZ 85006 (e-mail: [email protected]).
Abstract
Keywords
► ► ► ►
wear osteolysis bone defects revision total knee arthroplasty
Wear and osteolysis are common problems that often require revision surgery following total knee arthroplasty (TKA). Wear rates can be reduced through proper implant positioning and the use of modern, highly cross-linked polyethylene liners. More research is needed to identify medications that could prevent or treat the bone loss associated with osteolysis. Bone defects resulting from osteolysis can be managed with a variety of bone-preserving strategies and often require the use of structural augmentation, either in the form of bulk allografts or metal augments. Recently, porous metal augments such as tantalum cones have gained popularity among surgeons performing revision TKA for osteolytic bone defects with promising early clinical results. A megaprosthesis with a rotating hinge device may be used in salvage cases for severe bone deficiencies.
Wear and osteolysis are two of the most common problems necessitating revision after total knee arthroplasty (TKA). A recent study of revision TKA in the United States found that after infection (25.2%), mechanical loosening (16.1%) is the second most common reason reported for the revision of a total knee.1 When combined with the often related and concomitant problems of osteolysis (3.3%) and bearing surface wear (4.9%),2 mechanical loosening accounts for just under 25% of all revision TKAs in the United States.1 With over 50,000 revision TKAs performed each year, problems related to component wear and loosening account for more than 12,000 revisions annually at an aggregate cost of around $625 million.1,3 Early surgical series reported rates of osteolysis based on radiographs following TKA from 16 to 35% with follow-up in the 5- to 10-year range.4,5 Despite these high rates of radiographic osteolysis, most patients continued to progress well from a clinical standpoint.4 More modern series have shown much lower rates of radiologic osteolysis, with reports rang-
ing from 0% at mean follow-up of 4 years6 to
139
Wear and Loosening in Total Knee Arthroplasty: A Quick Review James F. Fraser, MD, MPH1
Steven Werner, DO2
David J. Jacofsky, MD3
1 Department of Orthopedics, Banner Good Samaritan Hospital,
Phoenix, Arizona 2 Division of Adult Reconstruction, The CORE Institute, Center for Orthopedic Research and Education, Phoenix, Arizona 3 The CORE Institute, Center for Orthopedic Research and Education, Phoenix, Arizona
Address for correspondence James F. Fraser, MD, MPH, Department of Orthopedics, Banner Good Samaritan Hospital, 1320 N. 10th Street, Suite A, Phoenix, AZ 85006 (e-mail: [email protected]).
Abstract
Keywords
► ► ► ►
wear osteolysis bone defects revision total knee arthroplasty
Wear and osteolysis are common problems that often require revision surgery following total knee arthroplasty (TKA). Wear rates can be reduced through proper implant positioning and the use of modern, highly cross-linked polyethylene liners. More research is needed to identify medications that could prevent or treat the bone loss associated with osteolysis. Bone defects resulting from osteolysis can be managed with a variety of bone-preserving strategies and often require the use of structural augmentation, either in the form of bulk allografts or metal augments. Recently, porous metal augments such as tantalum cones have gained popularity among surgeons performing revision TKA for osteolytic bone defects with promising early clinical results. A megaprosthesis with a rotating hinge device may be used in salvage cases for severe bone deficiencies.
Wear and osteolysis are two of the most common problems necessitating revision after total knee arthroplasty (TKA). A recent study of revision TKA in the United States found that after infection (25.2%), mechanical loosening (16.1%) is the second most common reason reported for the revision of a total knee.1 When combined with the often related and concomitant problems of osteolysis (3.3%) and bearing surface wear (4.9%),2 mechanical loosening accounts for just under 25% of all revision TKAs in the United States.1 With over 50,000 revision TKAs performed each year, problems related to component wear and loosening account for more than 12,000 revisions annually at an aggregate cost of around $625 million.1,3 Early surgical series reported rates of osteolysis based on radiographs following TKA from 16 to 35% with follow-up in the 5- to 10-year range.4,5 Despite these high rates of radiographic osteolysis, most patients continued to progress well from a clinical standpoint.4 More modern series have shown much lower rates of radiologic osteolysis, with reports rang-
ing from 0% at mean follow-up of 4 years6 to
