• Michele Vasso, Philippe Beaufils, Simone Cerciello, and Alfredo Schiavone Panni.
• Department of Medicine and Science for Health, University of Molise, Via Francesco De Sanctis, Campobasso, Italy, vassomichele@gmail.com.
• Arch Orthop Trauma Surg. 2014 Apr 1;134(4):543-53.

IntroductionThe management of bone loss is a crucial aspect of the revision knee arthroplasty. Bone loss can hinder the correct positioning and alignment of the prosthetic components, and can prevent the achievement of a stable bone-implant interface. There is still controversy regarding the optimal management of knee periprosthetic bone loss, especially in large defects for which structural grafts, metal or tantalum augments, tantalum cones, porous metaphyseal sleeves, and special prostheses have been advocated. The aim of this review was to analyze all possible causes of bone loss and the most advanced strategies for managing bony deficiency within the knee joint reconstruction.Materials And MethodsMost significant and recent papers about the management of bone defects during revision knee arthroplasty were carefully analyzed and reviewed to report the most common causes of bone loss and the most effective strategies to manage them.ResultsModular metal and tantalum augmentation showed to provide more stable and durable knee revisions compared to allografts, limited by complications such as graft failure, fracture and resorption. Moreover, modular augmentation may considerably shorten operative times with a potential decrease of complications, above all infection which has been frequently associated to the use of allografts.ConclusionsModular augmentation may significantly reduce the need for allografting, whose complications appear to limit the long-term success of knee revisions.

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