Replacement of extensive bone defects in revision knee arthroplasty: Clinical cases

BACKGROUND: Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries; however, the annual increase in the number of TKAs predictably increases the number of revision interventions. The key reasons for revision TKA (reTKA) are aseptic instability, paraimplant infection, postoperative contractures, and periprosthetic fractures. The metaphyseal fixation in reTKA is performed with metaphyseal sleeves, trabecular metal reconstructive cones, or metaphyseal cones made of pure titanium. CLINICAL CASES DESCRIPTION: This study aimed to investigate and demonstrate the outcomes of reTKAs performed according to our algorithm with various metaphyseal fixators (sleeves and cones). Systematic reviews and meta-analyses do not allow claiming the advantage of one or another metaphyseal fixator with complete certainty, and this issue remains debatable. We report clinical cases that demonstrate the potential of the suggested algorithm for choosing a metaphyseal fixator in TKA, which ensures successful supplements of bone defects, correct spatial orientation, and good clinical and functional outcomes. CONCLUSION: This study reveals that this new algorithm for choosing a metaphyseal fixator in reTKAs allows for the correct selection of a replacement implant to ensure stable rotational and axial fixation.