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VIERNES / FRIDAY
294
DEALING WITH SEVERE
FEMORAL BONE LOSS
K. R. Berend MD,
A. V. Lombardi, Jr., MD., FACS
Joint Implant Surgeons, Inc.; the New
Albany Surgical Hospital; New Albany,
Ohio Departments of Orthopedics
and Biomedical Engineering; the
Ohio State University OH, USA
As the population ages and as the longevity
of total knee arthroplasty (TKA) increases,
surgeons are faced with more and more
complex reconstructive scenarios. Managing
femoral bone loss in revision and complex
primary TKA is one of these complex surgical
problems. For many years, the orthopedic
oncology world has dealt with distal femoral
bone loss with the use of modular distal
femoral replacement prostheses. Long-term
concerns over fi xation, stress shielding, and
bearing wear have plagued the successful
tumor surgery. In revision TKA, the available
bone stock, both in terms of quality
and quantity, are signifi cantly affected. This
makes successful fixation the first major
issue. Options for reconstruction of distal
femoral bone loss include allograft-prosthesis
composite constructs and distal femoral
replacements. Each option has its own set
of benefi ts and drawbacks. Fixation options
include the use of cemented stems, porous
coated designs, and now newer compression
loaded devices. Again, each alternative carries
a certain risk versus benefi t that must be
weighed by the surgeon. The current authors
prefer the use of distal femoral replacement
in these complex cases. Our experience with
managing severe distal femoral bone loss in
TKA is reviewed. The use of various fi xation
modalities and newer novel alternatives are
presented.
THE ADVANTAGE
OF CONSTRAINT IN
REVISION SURGERY
K. Steinbrink
Evangelisches Krankenhaus Alsterdof
Hamburg, Germany
THE ROLE OF IMPLANT
CONSTRAINT
K. R. Berend MD,
A. V. Lombardi, Jr., MD., FACS
Joint Implant Surgeons, Inc.; the New
Albany Surgical Hospital; New Albany,
Ohio Departments of Orthopedics
and Biomedical Engineering; the
Ohio State University OH, USA
As the degree of deformity, bone loss,
contracture, ligamentous instability and
osteopenia increases, so does the demand
for prosthetic constraint. The workhorse in
revision TKA is the posterior stabilized constrained
(PSC) design. There is a continuum
of constraint available that ranges from CR, to
a CR lipped device, to an anterior stabilized
device, to a posterior stabilized device, to a
PS “plus” with varus-valgus constraint, to a
PSC, to a rotating hinge. The senior author’s
revision TKA experience includes 985 revision
TKA performed from 1988 through 2005.
A PSC device was used in 540 knees (55%),
cruciate retaining in 49 (5%), posterior stabilized
in 200 (20%), and rotating hinge in 195
(20%). A single PSC design (Maxim; Biomet,