Contemporary bone loss options: Rebuild, reinforce, and augment

Bone loss remains a major clinical challenge in revision total knee arthroplasty (TKA). Sources of bone loss include wear debris-induced osteolysis, infection, stress shielding, and periprosthetic fracture. Preoperative and intraoperative evaluations are necessary to classify the degree of bone loss in the revision setting including the location, size, and containment of defects. Reconstructive options for smaller, contained defects include morselized autograft/allograft, cementation with or without screw fixation, and metallic augments. For larger uncontained defects, structural allograft, metallic augments/cones, and prosthetic salvage systems become more common treatment options. Restoration of the bony envelope to provide support to the revision prosthesis is critical for a successful clinical outcome.