{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:25:43Z","timestamp":1791379543923,"version":"4.3.3"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The primary purpose of the study was to use pre\u2010revision total knee arthroplasty (TKA) computer\u2010tomography (CT)\u2010images to analyse typical tibial bone defects and create a new schematic three\u2010dimensional (3D)\u2010classification system. The secondary purpose was to investigate the association between defect size and implant selection at the time of revision surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Eighty\u2010four patients with preoperative CT\u2010scans underwent revision of a primary TKA. CT\u2010image segmentation with the 3D\u2010Slicer Software was performed retrospectively, and a new three\u2010dimensional classification system was used to grade tibial bone defects. The location of tibial bone defects was recorded for all cases. Volumetric 3D bone defect measurements were used to investigate the association between the bone defect volume, the indication for rTKA, and the use of modular revision components. The\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test, the Mann\u2013Whitney\u2010\n                      <jats:italic>U<\/jats:italic>\n                      test, and the Fisher's exact\u2010test were used for group comparisons, and the Kruskal\u2013Wallis test was used for multiple group comparisons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The most common anatomic regions for both contained and uncontained tibial bone defects were the anteromedial epiphysis (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200950; mean epiphyseal\u2010defect: 5.9\u2009cm\u00b3) and metaphysis (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200915; mean metaphyseal\u2010defect: 9.6\u2009cm\u00b3). A significant association was found between patients with preoperative metaphyseal defects (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200922) and the use of tibial augments (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20097) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). The use of cones\/sleeves was associated with a significantly increased 3D\u2010CT volume of the preoperative metaphyseal bone defects (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Patients with osteoporosis had significantly larger volumetric defects in the metaphysis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results emphasise the importance of considering the three\u2010dimensional nature of tibial defects in rTKA. The findings suggest that an understanding of the volume of the defect size through CT imaging can predict the need for augments and cones\/sleeves and, especially in patients with osteoporosis can help the surgeon identify larger metaphyseal defects and ensure optimal metaphyseal fixation through appropriate implant selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.12061","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T06:00:31Z","timestamp":1706680831000},"page":"323-333","source":"Crossref","is-referenced-by-count":8,"title":["Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7811-7493","authenticated-orcid":false,"given":"Marco","family":"Brenneis","sequence":"first","affiliation":[{"name":"Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery New York New York USA"},{"name":"Department of Orthopaedics (Friedrichsheim) University Hospital Frankfurt, Goethe University Frankfurt\/Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios A.","family":"Flevas","sequence":"additional","affiliation":[{"name":"Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Braun","sequence":"additional","affiliation":[{"name":"Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter K.","family":"Sculco","sequence":"additional","affiliation":[{"name":"Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Boettner","sequence":"additional","affiliation":[{"name":"Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery New York New York 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