SPECIAL CONSIDERATIONS IN KNEE REVISION OF ASIANS

Introduction

3 main challenges encountered in knee revision of Asians:

1. systemic: such as osteoporosis and laxity

2. anatomical variance: established in literature making revision system not appropriate

3. Neglected case revised late owes to extensive bone loss demanding bone substitute and increased constrain

Therefore we like to alert surgeon apprehending enhanced challenges while indulging in revision of Asian.

Our emiratus author with USA background/qualification/experience has excuted 216 revision in 8yrs with at least 3yrs follow-up.

Material & Method

Between 2003–2010 we performed 216 revision TKR, reviewed all parameters & compared our results with European revision statistics depicting a) intermedullary canal smaller b) metaphysis narrower & more triangular in comparision to Caucasian causing housing mechanism fit impossible, also increase impingment of stem at times.

Bone loss is normally quiet extensive & available implant including the Tantalum cone sometimes is difficult to fit in a tight metaphyseal area, we had satisfactory outcome inspite of owing to intra-operative complication which lead to 3 intramedullary fracture resulting from inadequate avalibity of smaller size, incomplete seating of tibial component, overhang of femoral component.it also leads to more translucent line quoted in 15 cases.

Centre of IM canal in both tibia & femur is positioned more posteriorly especially in smaller size proven by CT anatomical study analysis.

These data we related to anatomic variance rather then surgical technique therefore representing deficit of proper size thereby contributing to inability to surgeon.

Conclusion

Restoring joint line to tibia to prevent impingment of tibial housing is crucks, enabled by utilizing certain surgical tricks which all surgeon revising small stature Asian should bear in mind.in certain instances use totally cemented stubby stem.

2 important aspect of our abstract:

1. a)

   Present: we will review all tricks enabling appropriate/maximum utilization of inadequate current revision system.

2. b)

   Future: we will also present specific recommendation to Industry based on anatomy variation alerting them need of

   1. 1)

      asymmetrical tibial component

   2. 2)

      natural femoral component

   3. 3)

      repositioning of stem

Multiple factors contributes more challenges in Asian revision:

1. 1)

   mainly anatomy attributed to metaphyseal morphology.

2. 2)

   unable to apply certain surgical tricks to fit implant in small patient

strong recommendation to Industry to alter revision system inorder to achieve more success in Asian revision surgery