الفهرس 
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Abstract
In revision total knee arthroplasty (TKA) cases and when massive bone loss in present, three difference zones of fixation are identified in both femur and tibia.
Zone one referes to epihysis, joint surface and proximal cortical bone, zone two refers to metaphysis and zone three refers to diaphysis. In revision cases zone one always compromised while zone two and three should be structurally stable to support revision prosthesis.
Zone one can be reconstructed by screws and polymethyl methacrylate (PMMA). Cement are utilized with defect less than 5-10 millimeters (mm). Zone two defects can be handled by prosthetic wedge and blocks. They are useful in 5-20 millimeter (mm) unicondylar defect and not sufficient for larger bone defect, while in zone three structural stability can be achieved by intramedullary fixation through stemmed componenent of various (shape or length).
The complications of revision total knee arthroplasty can be divided into two major categoris, septic and aseptic failure, the latter, namely aseptic failure, includes instability, loosening, device fracture, osteolysis, wear and periprostehtic fracture.
The uses of metaphyseal sleeves and cones increased in revision total knee arthroplasty. Metaphyseal sleeves are able to provide axial support, rotation stability and bone fixation due to bone integration and they can be used in type two A, B and type three, Anderson orthopaedic research institute (AORI) classification.
Metaphyseal cones are considered to be effective option in management of bone defects in type two and three metaphyseal defects. Divided into titanium cones and tantalum cones, the advantage of tantalum cones that there are multiple shapes and sizes to accomoodate a large portion of bone defects in moderate to severe range of bone loss. While advantage of titanium cones include better axial alignment due to uses of intramedullary fixation guided bone preparation system.