This 2011 AAOS review by Haidukewych et al examines why and how to target the metaphysis for fixation in revision TKA — covering cementation strategies, structural and particulate allograft, trabecular metal cones, and porous-coated sleeves — and how to match each technique to defect severity using the AORI classification.
When you encounter AORI type 2 or 3 defects at revision TKA, plan for metaphyseal fixation — either hybrid cementation, porous cones, or instrumented sleeves. Because relying on epiphyseal fixation or short metaphyseal-only press-fit stems carries failure rates exceeding 15%.
Structural allograft remains an option but demands high surgical volume and carries meaningful mid-term failure risk from resorption.
This 2011 AAOS review by Haidukewych et al examines why and how to target the metaphysis for fixation in revision TKA — covering cementation strategies, structural and particulate allograft, trabecular metal cones, and porous-coated sleeves — and how to match each technique to defect severity using the AORI classification.
When you encounter AORI type 2 or 3 defects at revision TKA, plan for metaphyseal fixation — either hybrid cementation, porous cones, or instrumented sleeves. Because relying on epiphyseal fixation or short metaphyseal-only press-fit stems carries failure rates exceeding 15%.
Structural allograft remains an option but demands high surgical volume and carries meaningful mid-term failure risk from resorption.