Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-04-2021 | Bone Defect | Orthopaedic Surgery

Preliminary clinical results of coated porous tibia cones in septic and aseptic revision knee arthroplasty

Authors: Malte Ohlmeier, Christian Lausmann, Matthias Wolff, Hussein Abdelaziz, Thorsten Gehrke, Mustafa Citak

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2021

Abstract

Purpose

To analyze the first results of calcium-phosphate-coated porous tibia cones.

Methods

Patients treated with TrabecuLink^®-CaP Cones were retrospectively recruited from January 2016 to December 2017. These custom-made cones were produced using titanium alloy Ti–6Al–4 V (Tilastan^®) and using additive manufacturing with a special calcium-phosphate coating (HX^®-coating). Clinical outcome was evaluated using Oxford Knee Score. For radiological evaluation of the implants, patients sent us outpatient taken radiographs. A minimum follow-up of one year was required. Lastly, we analyzed postoperative complications and revision rates.

Results

52 patients with revision knee arthroplasty (RKA) were recruited for final analysis, of whom, we had 17 septic RKAs (33%) and 35 aseptic cases of RKA (67%). The bone defects were grouped into 17 AORI Type 2A (32.7%), 14 Type 2B (26.9%) and 21 Type 3 (40.4%). After a mean follow-up of 22 months (13.2–34.8; SD = ± 10), we had 4 surgical revisions (7.7%), 2 septic and 2 aseptic cases. The mean Oxford Knee Score was 28.6 points (8–47; SD = ± 10). 22 of 28 radiographs (78.6%) showed regular positioning of the cones and TKAs at a mean follow-up of 16.8 months (13.2–34.8; SD = ± 6). Three patients (10.7%) showed slight radiolucencies in the bone–cement interfaces and 3 patients (10.7%) had beginning heterotopic ossifications.

Conclusions

This study shows the initial clinical results of calcium-phosphate-coated tibia cones showing a good functional outcome. Further research should focus on long-term clinical and radiological follow-up.

Lachiewicz PF, Watters TS (2014) Porous metal metaphyseal cones for severe bone loss: when only metal will do. Bone Joint J 96-B(11 Suppl A):118–121. https://doi.org/10.1302/0301-620X.96B11.34197CrossRefPubMed

Bonanzinga T, Gehrke T, Zahar A et al (2018) Are trabecular metal cones a valid option to treat metaphyseal bone defects in complex primary and revision knee arthroplasty? Joints 6(1):58–64. https://doi.org/10.1055/s-0037-1608950CrossRefPubMed

Levine B, Sporer S, Della Valle CJ et al (2007) Porous tantalum in reconstructive surgery of the knee: a review. J Knee Surg 20(3):185–194CrossRef

You JS, Wright AR, Hasegawa I et al (2019) Addressing large tibial osseous defects in primary total knee arthroplasty using porous tantalum cones. Knee 26(1):228–239. https://doi.org/10.1016/j.knee.2018.11.001CrossRefPubMed

Burastero G, Cavagnaro L, Chiarlone F et al (2018) The use of tantalum metaphyseal cones for the management of severe bone defects in septic knee revision. J Arthroplasty 33(12):3739–3745. https://doi.org/10.1016/j.arth.2018.08.026CrossRefPubMed

Engh GA, Ammeen DJ (1999) Bone loss with revision total knee arthroplasty: Defect classification and alternatives for reconstruction. Instr Course Lect 48:167–175PubMed

Meneghini RM, Lewallen DG, Hanssen AD (2008) Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am 90(1):78–84. https://doi.org/10.2106/JBJS.F.01495CrossRefPubMed

Faizan A, Bhowmik-Stoker M, Alipit V et al (2017) Development and verification of novel porous titanium metaphyseal cones for revision total knee arthroplasty. J Arthroplasty 32(6):1946–1953. https://doi.org/10.1016/j.arth.2017.01.013CrossRefPubMed

Beckmann NA, Mueller S, Gondan M et al (2015) Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones-a systematic review, vol 2, United States

10.

Fedorka CJ, Chen AF, Pagnotto MR et al (2018) Revision total knee arthroplasty with porous-coated metaphyseal sleeves provides radiographic ingrowth and stable fixation. Knee Surg Sports Traumatol Arthrosc 26(5):1500–1505. https://doi.org/10.1007/s00167-017-4493-yCrossRefPubMed

11.

Sculco PK, Abdel MP, Hanssen AD et al (2016) The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 98-B(11 Suppl A):120–124. https://doi.org/10.1302/0301-620X.98B1.36345CrossRefPubMed

12.

Henricson A, Linder L, Nilsson KG (2008) A trabecular metal tibial component in total knee replacement in patients younger than 60 years: a two-year radiostereophotogrammetric analysis. J Bone Joint Surg Br 90(12):1585–1593. https://doi.org/10.1302/0301-620X.90B12.20797CrossRefPubMed

13.

Heinl P, Muller L, Korner C et al (2008) Cellular Ti-6Al-4V structures with interconnected macro porosity for bone implants fabricated by selective electron beam melting. Acta Biomater 4(5):1536–1544. https://doi.org/10.1016/j.actbio.2008.03.013CrossRefPubMed

14.

Wang H, Zhao B, Liu C et al (2016) A comparison of biocompatibility of a titanium alloy fabricated by electron beam melting and selective laser melting. PLoS ONE 11(7):e0158513. https://doi.org/10.1371/journal.pone.0158513CrossRefPubMedPubMedCentral

15.

de Martino I, de Santis V, Sculco PK et al (2015) Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res 473(10):3176–3182. https://doi.org/10.1007/s11999-015-4338-2CrossRefPubMedPubMedCentral

16.

Bidan CM, Kommareddy KP, Rumpler M et al (2012) How linear tension converts to curvature: geometric control of bone tissue growth. PLoS ONE 7(5):e36336. https://doi.org/10.1371/journal.pone.0036336CrossRefPubMedPubMedCentral

17.

Joly P, Duda GN, Schöne M et al (2013) Geometry-driven cell organization determines tissue growths in scaffold pores: consequences for fibronectin organization. PLoS ONE 8(9):e73545. https://doi.org/10.1371/journal.pone.0073545CrossRefPubMedPubMedCentral

18.

Gehrke T, Zahar A, Kendoff D (2013) One-stage exchange: it all began here. Bone Joint J 95-B(11 Suppl A):77–83. https://doi.org/10.1302/0301-620X.95B11.32646CrossRefPubMed

19.

Murray DW, Fitzpatrick R, Rogers K et al (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89(8):1010–1014. https://doi.org/10.1302/0301-620X.89B8.19424CrossRefPubMed

20.

Hamilton DF, Giesinger JM, Patton JT et al (2015) Making the Oxford Hip and Knee Scores meaningful at the patient level through normative scoring and registry data. Bone Joint Res 4(8):137–144. https://doi.org/10.1302/2046-3758.48.2000524CrossRefPubMedPubMedCentral

21.

Denehy KM, Abhari S, Krebs VE et al (2019) Excellent metaphyseal fixation using highly porous cones in revision total knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2019.03.045CrossRefPubMed

22.

Trombetta RP, Ninomiya MJ, El-Atawneh IM et al (2019) Calcium phosphate spacers for the local delivery of sitafloxacin and rifampin to treat orthopedic infections: efficacy and proof of concept in a mouse model of single-stage revision of device-associated osteomyelitis. Pharmaceutics. https://doi.org/10.3390/pharmaceutics11020094CrossRefPubMedPubMedCentral

23.

Chernozem RV, Surmeneva MA, Krause B et al (2019) Functionalization of titania nanotubes with electrophoretically deposited silver and calcium phosphate nanoparticles: structure, composition and antibacterial assay. Mater Sci Eng C Mater Biol Appl 97:420–430. https://doi.org/10.1016/j.msec.2018.12.045CrossRefPubMed

24.

Wang Di, Wang Y, Wu S et al (2017) Customized a Ti6Al4V bone plate for complex pelvic fracture by selective laser melting. Materials (Basel). https://doi.org/10.3390/ma10010035CrossRefPubMedPubMedCentral

25.

Gordeev EG, Galushko AS, Ananikov VP (2018) Improvement of quality of 3D printed objects by elimination of microscopic structural defects in fused deposition modeling. PLoS ONE 13(6):e0198370. https://doi.org/10.1371/journal.pone.0198370CrossRefPubMedPubMedCentral

26.

Bassous NJ, Jones CL, Webster TJ (2019) 3-D printed Ti-6Al-4V scaffolds for supporting osteoblast and restricting bacterial functions without using drugs: Predictive equations and experiments. Acta Biomater. https://doi.org/10.1016/j.actbio.2019.06.055CrossRefPubMed

27.

Papas PV, Congiusta D, Cushner FD (2019) Cementless versus cemented fixation in total knee arthroplasty. J Knee Surg 32(07):596–599. https://doi.org/10.1055/s-0039-1678687CrossRefPubMed

28.

Fricka KB, McAsey CJ, Sritulanondha S (2019) To cement or not? five-year results of a prospective, randomized study comparing cemented vs cementless total knee arthroplasty. J Arthroplasty 34(7S):S183–S187. https://doi.org/10.1016/j.arth.2019.02.024CrossRefPubMed

29.

Sultan AA, Mahmood B, Samuel LT et al (2019) Cementless 3D printed highly porous titanium-coated baseplate total knee arthroplasty: survivorship and outcomes at 2-year minimum follow-up. J Knee Surg. https://doi.org/10.1055/s-0039-1677842CrossRefPubMed

30.

Mancuso F, Beltrame A, Colombo E et al (2017) Management of metaphyseal bone loss in revision knee arthroplasty. Acta Biomed 88(2S):98–111. https://doi.org/10.23750/abm.v88i2CrossRefPubMedPubMedCentral

31.

Abdelaziz H, Jaramillo R, Gehrke T et al (2019) Clinical survivorship of aseptic revision total knee arthroplasty using hinged knees and tantalum cones at minimum 10-year follow-up. J Arthroplasty 34(12):3018–3022. https://doi.org/10.1016/j.arth.2019.06.057CrossRefPubMed

Title: Preliminary clinical results of coated porous tibia cones in septic and aseptic revision knee arthroplasty
Authors: Malte Ohlmeier
Christian Lausmann
Matthias Wolff
Hussein Abdelaziz
Thorsten Gehrke
Mustafa Citak
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keyword: Bone Defect
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2021
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03434-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Preliminary clinical results of coated porous tibia cones in septic and aseptic revision knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2021

Greater trochanter fractures in the direct anterior approach: evolution during learning curve, risk factors and consequences

Risk adapted diagnostics and hospitalization following mild traumatic brain injury

Failure analysis of infection persistence after septic revision surgery: a checklist algorithm for risk factors in knee and hip arthroplasty

Long-term results after internal partial forefoot amputation (resection): a retrospective analysis

Is limited shoulder abduction associated with poor scapulothoracic mobility after reverse shoulder arthroplasty?

Fracture reduction and screw position after 3D-navigated and conventional fluoroscopy-assisted percutaneous management of acetabular fractures: a retrospective comparative study