Abstract
The aim of this study is to assess the extent of osteolysis around a TKR which would then help in effective planning of revision surgery.
Osteolysis around a TKR can be difficult to identify in plain radiographs because this typically occurs in low radiodensity cancellous bone of distal femur and proximal tibia. These can often look innocuous and benign allowing the surgeon to fall into a false sense of security.
We discuss the use of 3 dimensional CT scan in 7 cases with pre revision initially unsuspected massive osteolysis and its usefulness in planning appropriate implant and/or bone grafting technique in revision surgery.
6/7 knees had a primary cruciate retaining knee implant and the mean time to revision surgery was 11 years and 8 months
Based on our pre operative CT assessment we were able to plan and effectively undertake 3 custom built prosthesis and 4 stemmed revision implants along with the use of adjunct bone additives including allograft.
On the basis of this experience we would recommend the routine use of a 3D CT scan in preoperatively assessing a revision TKR and would caution the appearance particularly of the ‘posterior femoral bubble’ as it often belies a large osteolytic cavity.
Honorary Secretary – Mr Roger Smith. Correspondence should be addressed to BASK at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN
