MANAGEMENT MAN NT O OF BO F BONE L LOSS IN RE IN REVI VISION - - PowerPoint PPT Presentation

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MANAGEMENT MAN NT O OF BO F BONE L LOSS IN RE IN REVI VISION - - PowerPoint PPT Presentation

MANAGEMENT MAN NT O OF BO F BONE L LOSS IN RE IN REVI VISION TKA N TKA Douglas Doug las A A. Dennis Dennis, M. M.D. D. Adjun junct ct Prof ofes essor or, Depar artm tmen ent t of Biom iomed edica cal l Enginee neering


slide-1
SLIDE 1

Doug Douglas las A

  • A. Dennis

Dennis, M. M.D. D.

Adjun junct ct Prof

  • fes

essor

  • r, Depar

artm tmen ent t of Biom iomed edica cal l Enginee neering ng Univ iversity ty of Tenne nnessee Adjun junct ct Prof

  • fes

essor

  • r of Bioen

ioenginee neering ng Univ iversity ty of Denver er Clini linical cal Dir irec ecto tor Roc

  • cky Mount

ntai ain n Muscul culos

  • skel

elet etal al Resear arch h Labor

  • rator
  • ry

Denver er, Color

  • rad

ado

MAN MANAGEMENT NT O OF BO F BONE L LOSS IN IN RE REVI VISION TKA N TKA

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SLIDE 2

DISCLO DISCLOSURE

Cons

  • nsult

ultan ant : t : Depuy puy Roy

  • yalt

alties ies: :

  • Depuy

uy / / Innom nnomed ed / / Wolt

  • lter

ers K Kluw uwer

Labo borato atory R Resear earch ch S Suppo pport rt

  • Depuy

uy

  • Por

Porter er A Adven entis ist H t Hosp

  • spit

ital al

Owner ership I hip Int nteres erest: t: J Joint int Vue ue

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SLIDE 3

BON ONE DE DEFE FECT CTS IN REVISION TKA KA

It’s

t’s A Already ready Gone! ne!!!

  • Pr

Previ vious TKA s TKA

It’s

t’s More T re Than han Y You T

  • u Think

hink!

  • Xra

rays ys Underes nderestim timate ate

  • Bon
  • ne L

e Los

  • ss F

From rom T TKA Remo moval al

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SLIDE 4

BONE BONE DEF DEFECT OPTI T OPTIONS

Cemen

ment t + Screw ews

Modu

dular A lar Aug ugmen mentatio ations

  • We

Wedge / / Blo lock

  • Meta

taphyseal eal Sleev Sleeves / / Cones

  • nes

Bone Graft

Graft

  • Morcelliz

rcellized ed Vs. S . Structu ructural al

  • Auto

utograft raft Vs. A . Allog lograft raft

slide-5
SLIDE 5

CEMENT CEMENT ± SCRE SCREWS

Ve

Very Li Littl ttle Publ ublishe shed In d In Revi visi sion TK

  • n TKA S

Setti tting ng

RECOMME

MENDATION TION:

  • Smalle

ller D r Defects fects (< 5 (< 5-10m 10mm) I In Eld lderly rly, Low Low Dema mand nd P Pati tients nts

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SLIDE 6

CEME CEMENT ± SCREW SCREWS REVI REVISION T TKA KA

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SLIDE 7

AUGMENTATI ENTATION: ADV DVAN ANTAG TAGES

No

No Risk sk Of Of:

  • Dise

sease se Tr Transmi nsmissi ssion

  • n
  • Ma

Maluni union

  • n / Nonuni

/ Nonunion

  • n

Imme

Immedi diate S Suppor upport

Good Loa

Good Load Tr d Trans nsmi missi ssion

  • n
  • Brook
  • oks, Walk

lker, et al, l, CORR, RR, 1984 984

Techni

hnica cal S l Simpli lici city ty

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SLIDE 8

AUGME GMENTATION: DI DISADV DVANTAGES

Size

Size & Sha & Shape Lim Limited

Not A

  • t Amen

enable I able In L Large rge Bon

  • ne D

e Defect ects

Debris

bris C Creatio eation

  • Modu

dular I lar Int nterf erfac ace

Cos

Costly y

24 Yr Postop

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SLIDE 9

AUGEM EMENTATI NTATION R ON RESULTS SULTS

79 Rev.

  • v. TK

TKA

Me

Mean F/U n F/U 7 Yr

  • Yrs. (5
  • s. (5-11)

11)

AOR

ORI Type I Type II D II Defects ts

176 A

Augme ugments Use nts Used d

  • Femur &

& Tibi bia

14%

% Radi diol

  • luc

ucent Li nt Line nes

  • Unassoci

ciated ated W With th F Failure re

92% 1

% 11 Ye Year Sur urvi viva val

Patel, Bourne, et al, Br. JBJS, 2004

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SLIDE 10

METAPHY APHYSEA SEAL S L SLEEV EVES ES

“Metap

etaphysea eal Augme ugmenta ntations”

  • ns”

Femoral

ral & Tib ibia ial D l Defect fects

Enha

nhanc nce C Compone

  • mponent

nt Sta tabi bility ty

  • Impr

Improv

  • ved Fi

d Fixa xati tion

  • n

Ste

tep D p Desi sign gn

  • Pro

rogres ressiv ive e Me Meta taphys hyseal Loa Loadi ding ng

slide-11
SLIDE 11

METAPHY APHYSEA SEAL S L SLEEV EVES ES

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SLIDE 12

FE FEMO MORAL S SLE LEEVES

Pr

Provid ide F Fixat atio ion & & Ch Chosen S Siz ize e Determ termines es J Joint L Line

⇧ Size =

= Mor More D Dist stal Joi

  • int Li

Line

  • Init

itia ially lly I Inser ert Sma Smalle ller Sl Sleev eve / e / Bone

  • ne R

Rese sections ns

  • Trial

al R Reducti ction / / Determ termine e Desir ire J Join int L Lin ine L Lev evel el

  • Larg

arger Sl Sleev eve e To G Gain R Rigid id Fix ixation & & Des Desired Jo Joint Lin ine

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SLIDE 13

HEMA HEMATOGEN ENOUS MSSA S MSSA: 2 2-STA TAGE

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SLIDE 14

REIMPL MPLANTI ANTION: S SLEE EEVES

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SLIDE 15

METAPHY APHYSEA SEAL S L SLEEV EVES ES

Watte tters, Denni nnis, et al l J Arthr throplas asty ty 2017 17

116 R

Revi visi sion TK TKA

152

52 Metaphysea eal Sl l Sleev eves es

  • 41 F

1 Fem emoral / l / 111 11 Tibial al

Mean

an F F/U D Dura ratio ion: 5 5.3 Y 3 Year ears

  • 2

2 – 9.6 Y 6 Year ears

Type pe 2 2A - Femur ur 3 Type pe 2 2B - Femur ur 34 Type pe 3 3 - Femur ur 4 Type pe 2 2A - Ti Tibia 5 Type pe 2 2B - Ti Tibia 89 Type pe 3 3 - Ti Tibia 17

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SLIDE 16

RESU SULTS LTS

0.9 0.95 1 12 24 36 48 60 Percent Not Revised Time (months)

Sle leeve e Surviv ivorshi hip Curve

Survivorship - All Cause Revision of Metaphyseal Sleeve Revision for Asceptic Loosening of Metaphyseal Sleeve

97.8% Survivorship @ 5.3 Yrs

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SLIDE 17

TRABE BECUL CULAR M AR METAL C AL CONE NES

Courtesy, Arlen Hanssen, MD ADVANTAGE: Can Be Used With Multiple Implant Systems

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SLIDE 18

TRABE BECUL CULAR M AR METAL C AL CONES NES

66 R

Rev evis ision

  • n T

TKA W A With th T Tibia ial C l Cones

  • nes

Ty

Type 2 2A & & 2B o

  • r

r 3 Tib Tibial De Defects

Mean

an Fol Follo low-Up = = 70 M Months

  • nths

95% S

Survi vivo vorsh rship

Radi

diogr graph phic F Fibro brous I s Ingro rowt wth ( (2)

3 Revisio

ions ns: Loosen Loosening ing, I Inf nfect ectio ion, PP PP Fx Fx

Kamath, Lewallen, & Hanssen JBJS 2015

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SLIDE 19

BONE G NE GRAF AFT: T: ADV DVAN ANTAG TAGES

Restores B

Bone Stock

  • ne Stock (Futur

(Future R Revisio ions ns)

Can Shap

n Shape T e To

  • Fi

Fit t Defect

Cost

  • st-Effectiv

ive (A e (Aut utolog logous us)

Use

seful I l In n La Large D Defect cts (> (>15 m 15 mm)

Mor

  • re Phys

e Physio iolog logic Loa c Load T Tran ansfer

  • If Incor
  • rpor
  • rati

ation O n Occur urs

Sh Shriv ivas astava et et al, al, J J Biomech mech 1982 82

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SLIDE 20

BONE G NE GRAF AFT: T: DISAD ADVAN VANTAG TAGES

Nonun

Nonunion

  • n /

/ Malunion nion

Late Col

Late Collapse

Diseas

sease T e Trans nsmis mission ion

Techniqu

hnique S e Sensi nsitive tive

Amount

nt / / Size L ize Limit ited ed

  • Autog

Autograft ft

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SLIDE 21

REVISI REVISION ON TK TKA: A: CON CONTAINED DE D DEFE FECT CTS

Sm

Small C all Cont

  • ntain

ained B Bone D

  • ne Defects

ts

  • Impac

action ion Gr Graf afting ing

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SLIDE 22

STRUCT CTURAL A L ALLOGR LLOGRAFT FTS:

PREOPERATI RATIVE P PLANNI NNING NG

R/O I

Inf nfect ectio ion

  • ESR,

ESR, CRP CRP, & & WB WBC Co Count

  • Aspiratio

piration / Nuclear S uclear Scann nnin ing

»C &

& S / S / Alpha Defen ensin ins

»Dual /

ual / Trip iple I e Isot sotop

  • pe

Implan

plant S Selectio ection

  • Gl

Glob

  • bal I

l Inst nstab abili lity ty/ C Const

  • nstrain

int

  • Diaph

physe yseal Eng Engag aging ng Ste Stems

slide-23
SLIDE 23
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SLIDE 24
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SLIDE 25
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SLIDE 26
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SLIDE 27

14 Yr Postop

slide-28
SLIDE 28

MASSIVE O SIVE OSTEO EOLY LYSI SIS

slide-29
SLIDE 29

MASSIVE O SIVE OSTEO EOLY LYSI SIS

slide-30
SLIDE 30

STRUT UTUR URAL A AL ALLOGR OGRAFT AFT

slide-31
SLIDE 31

STRUCTU TURAL F RAL FEMORAL A AL ALLO LOGRAFT AFT

slide-32
SLIDE 32

78 78 YEAR MALE EAR MALE: LOOSE & OSE & FX

slide-33
SLIDE 33

DIS DISTAL TAL F FEM EMORAL RAL REPLACEMENT CEMENT

slide-34
SLIDE 34

SUMMA SUMMARY

Sma

Small ll Cavitary tary Defects ects

  • Mors

rseliz elized ed Graft aft

Non

  • n-Contai

tained ed D Defects ects (<15 m mm) m)

  • Cem

emen ent + Sc Scre rews ws

  • Modul

dular A Augm ugmentation

  • ns
  • Struct

ctural al A Auto tograf rafts ts / Allograf rafts ts

Large C

e Central tral D Defects ects

  • Me

Metaphyse yseal Sleeve ves / s / Con

  • nes
  • Bone
  • ne G

Graft

Larg

arge Nonco contai tained ed Defects ects

  • Struct

ctural al A Allograf rafts ts

  • Sleeve

ves / / Cone

  • nes
slide-35
SLIDE 35

THANK THANK YO YOU