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ISSN 2007-8560 (Print)
Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2018, Number 3

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Ortho-tips 2018; 14 (3)

Aseptic loosening in total knee arthroplasty

Reyes PV

Language: Spanish
References: 35
Page: 116-123
PDF size: 152.16 Kb.


ABSTRACT

Total knee arthroplasty (TKR) is the surgical procedure indicated in advanced gonarthrosis, with a success rate of about 90%. Aseptic loosening (AL) is currently the fourth cause of early failure in TKR requiring revision surgery. The physiopathology of aseptic loosening is developed mainly by microparticles and detritus of polyethylene and cement that generate an inflammatory reaction, causing osteolysis and subsequent loosening. The causes of aseptic loosening have fallen into three main categories: factors inherent to the patient, factors of the implant and factors related to the surgical technique. The majority of patients with TKR and osteolysis remain asymptomatic until implant failure, and there is no diagnostic study that allows early diagnosis of aseptic loosening with certainty. Improvements in the quality, manufacturing, handling and sterilization means of polyethylene have reduced the incidence of aseptic loosening in the last 20 years from 40% to 4% today. The gold standard for treatment is surgical; a revision surgery is indicated, which requires an adequate planning for the replacement and increases for implant fixation based on the degree of osteolysis according to the Anderson Orthopaedic Research Institute (AORI) classification. Traditionally, bone defects AORI 2B and 3 have been managed with structural allografts; however, the results have been variable. Currently, the use of augmentations with tantalum cones has given good results in solving bone defects, favoring osseointegration and eliminating problems associated with allografts.


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