A review of materials for managing bone loss in revision total knee arthroplasty

Romina Shafaghi; Omar Rodriguez; Emil H Schemitsch; Paul Zalzal; Stephen D Waldman; Marcello Papini; Mark R Towler

doi:10.1016/j.msec.2019.109941

A review of materials for managing bone loss in revision total knee arthroplasty

Mater Sci Eng C Mater Biol Appl. 2019 Nov:104:109941. doi: 10.1016/j.msec.2019.109941. Epub 2019 Jul 4.

Authors

Romina Shafaghi¹, Omar Rodriguez², Emil H Schemitsch³, Paul Zalzal⁴, Stephen D Waldman⁵, Marcello Papini⁶, Mark R Towler⁷

Affiliations

¹ Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto M5B 1W8, Ontario, Canada.
² Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto M5B 1W8, Ontario, Canada; Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada.
³ Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto M5B 1W8, Ontario, Canada; Department of Surgery, University of Western Ontario, London N68 4V2, Ontario, Canada.
⁴ Oakville Trafalgar Memorial Hospital, Oakville L6J 3L7, Ontario, Canada; Faculty of Health Sciences, Department of Surgery, McMaster University, Hamilton L8S 4L8, Ontario, Canada.
⁵ Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto M5B 1W8, Ontario, Canada; Department of Chemical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada.
⁶ Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada; Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada.
⁷ Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto M5B 1W8, Ontario, Canada; Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada. Electronic address: mtowler@ryerson.ca.

PMID: 31500053
DOI: 10.1016/j.msec.2019.109941

Abstract

In 2014-2015, 61,421 total knee arthroplasties (TKAs) were performed in Canada; an increase of about 20% over 2000-2001. Revision total knee arthroplasties (rTKAs) accounted for 6.8% of TKAs performed between 2014 and 2015, and this is estimated to grow another 12% by 2025. rTKAs are typically more complicated than primary TKAs due to the significant loss of femoral and tibial bone stock. The escalating demand and limitations associated with total knee arthroplasty and their revision drives the development of novel treatments. A variety of materials have been utilized to facilitate regeneration of healthy bone around the site of a knee arthroplasty. The selection of these materials is based on the bone defect size and includes bone grafts, graft substitutes and cements. However, all these materials have certain disadvantages such as blood loss, disease transmission (bone grafts), inflammatory response, insufficient mechanical properties (bone graft substitutes) thermal necrosis and stress shielding (bone cement). Recently, the use of metal augments for large bone defects has attracted attention, however they can undergo fretting, corrosion, and stress shielding. All things considered, this review indicates the necessity of developing augments that have structural integrities and biodegradation rates similar to that of human bone. Therefore, the future of bone loss management may lie in fabricating novel bioactive glass augments as they can promote bone healing and implant stability and can degrade with time.

Keywords: Augments; Bioactive glasses; Bone graft substitutes; Bone loss; rTKAs.

Publication types

Review

MeSH terms

Animals
Arthroplasty, Replacement, Knee / methods
Bone Cements / therapeutic use*
Bone Diseases, Metabolic / surgery*
Bone Transplantation / methods
Bone and Bones / surgery*
Humans
Knee Prosthesis
Prostheses and Implants

Substances

Bone Cements