• OBJECTIVE
    • Surgical technique for primary and revision total knee arthroplasty to reconstruct bone defects with metal augments and reproducible positioning of the implant at the right joint line.
  • INDICATIONS
    • Primary and revision total knee arthroplasty with bone defects.
  • CONTRAINDICATIONS
    • Complete destruction of the metaphysis.
  • SURGICAL TECHNIQUE
    • Implantation of revision components performed in three consecutive steps: first, positioning of the tibia component at correct height and rotation; second, determination of the posterior joint line in flexion through the size and correct rotation of the femoral implant; third, determination of the distal joint line by use of positioning of the femoral component. These steps are performed independently from bone defects, which are subsequently reconstructed with metal augments.
  • POSTOPERATIVE MANAGEMENT
    • Mobilization with weight bearing and range of motion as tolerated, depending on osseous and soft tissue condition at primary or revision surgery.
  • RESULTS
    • In a prospective study, 132 consecutive knee revisions in 76 women and 56 men with an average age of 72.4 years (range 49-93 years) were followed up clinically and radiologically preoperatively and at a mean follow-up of 74 months (range 38-105 months). Clinical results were based on the American Knee Society score. The score was 46.3 (range 31-65) preoperatively and 82.5 (range 61-96) at follow-up. Radiologically 12.1 % of the knees showed lysis around the augment with no clinical signs of loosening. No revisions were performed due to aseptic loosening. The joint line was correctly reconstructed in 84.8 %.