In vivo detachment of a tibial stemmed component and subsequent extraction.

Revision knee arthroplasty may be complicated by bone loss and limited bone contact can lead to high stresses at the bone implant interfaces and subsequent loosening. We report an unusual case of loosening of a revision knee implant and the novel technique used for its extraction prior to further revision.

Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss.

BACKGROUND: The use of impaction grafting in revisions with larger acetabular bone defects has mixed outcomes and sometimes high failures rates. PATIENTS AND METHODS: This prospective, single-center study involved a consecutive series of 24 patients who underwent complex reconstruction of the acetabulum using a trabecular metal augment, impaction bone grafting, and a cemented high-density polyethylene cup. Patients were followed for median 5 (3-7) years. RESULTS: The 2-year WOMAC pain, function, and stiffness scores improved, as did certain components (bodily pain, physical function, role physical, role emotional, physical component score, and social function) of the SF-36 (p < 0.05). 23 of the patients were very satisfied with the overall outcome of the surgery and would have undergone the surgery again for a similar problem, and 19 reported great improvement in their quality of life after surgery. Radiographs at the latest follow-up revealed incorporation of the augment with mean change in acetabular component inclination of less than 1 degree (p > 0.05) and cup migration of less than 5 mm in both horizontal and vertical axes (p > 0.05). 1 patient required further revision at 13 months and was found to have a fractured augment at re-revision. INTERPRETATION: This study shows that trabecular metal augments are effective in filling the bone defect and provide a stable foundation for impaction bone grafting. We found satisfactory clinical and radiographic results using this technique, with low failure rate at a median follow-up time of 5 years.