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Table 2 Decisional algorithm according to the modified AORI classification

From: Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

AORI Bone quality Treatment option
F1-T1 Good (G) • < 5 mm (< 50% of bone surface area)➔Cement and morselized bone
• 5–10 mm➔Cement and screw or morselized bone
Sclerotic (S) or osteoporotic (O) • Be sure to obtain adequate zone 3 (diaphysis) fixation
• If very sclerotic bone, consider small tantalum cone (disadvantage is to sacrifice bone stock
F2A-T2A Good (G) • 5–10 mm➔Cement and screw only if low demand patients
• > 5 mm; > 40% of surface unsupported from host bone➔Metal augments or structural allograft or impaction bone grafting (young patients)
• Need for adequate zone 3 fixation (stems)
Sclerotic (S) or osteoporotic (O) • Same option than before
• Adequate zone 2 fixation (cone) strongly recommended to reduce risk for aseptic loosening
F2B-T2B or type 3 defect Good (G) • Impaction bone grafting (young patients), metal augments, structural allograft
• Larger defect➔tantalum cone and titanium sleeve with short to medium-length stems
• Severe type 3 defect➔mega prosthesis
Sclerotic (S) or osteoporotic (O) • Same option than before
• Tantalum cone is often required to contemporarily treat bone loss and to enhance zone 2 fixation