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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