Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-01-2021 | Bone Defect | Knee Arthroplasty

Medium term clinical outcomes of tibial cones in revision knee arthroplasty

Authors: Roger Erivan, Robert Tracey, Aurélien Mulliez, Guillaume Villatte, Wayne Paprosky

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2021

Abstract

Introduction

Trabecular metal cones are a relatively new option for reconstruction of major bone defects during revision total knee arthroplasty (TKA). The purpose of the present study was to retrospectively assess medium-term results for tibial cones in revision TKA with a severe proximal tibial bone defect. We hypothesized that revision TKA patients with bone defects treated with trabecular metal cones have excellent medium-term clinical and radiological results.

Patients and methods

A single-center retrospective review included all consecutive cases of tibial revision using trabecular metal cones. All patients with a minimum 2-year follow-up were included in the study. There were no exclusion criteria. The primary endpoint was tibial cone survivorship. The secondary endpoints were revision TKA all-cause survivorship, patient-reported outcome measures with a Knee injury and Osteoarthritis Outcome Score (KOOS), SF 12, and radiographic analysis.

Results

Five of the 57 patients alive at last follow-up (8.77%) had undergone revision (4 for infection and 1 for instability). Complications comprised four cases (7.02%) of infection, 2 cases (3.51%) of tibial and femoral implant aseptic loosening that did not require revision surgery, 1 of which (1.75%) with associated patellar loosening, and 1 case (1.75%) of instability. Kaplan–Meier estimates showed 100% 5-year survivorship with tibial cone revision for aseptic loosening and 93.44% (95% CI 83.47–97.49%) for all-cause revision.

Discussion

The present study of cones used for tibial revision supports shows excellent results; however, longer and larger follow-up is needed to better assess results in revision TKA.

Level of evidence

4, retrospective study

Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785. https://doi.org/10.2106/JBJS.F.00222CrossRefPubMed

Hardeman F, Londers J, Favril A et al (2012) Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 20:1049–1056. https://doi.org/10.1007/s00167-011-1624-8CrossRef

Sheth NP, Bonadio MB, Demange MK (2017) bone loss in revision total knee arthroplasty: evaluation and management. J Am Acad Orthop Surg 25:348–357. https://doi.org/10.5435/JAAOS-D-15-00660CrossRefPubMed

Mancuso F, Beltrame A, Colombo E et al (2017) Management of metaphyseal bone loss in revision knee arthroplasty. Acta Bio-Medica Atenei Parm 88:98–111

Meijer MF, Boerboom AL, Stevens M et al (2017) Tibial component with and without stem extension in a trabecular metal cone construct. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 25:3644–3652. https://doi.org/10.1007/s00167-016-4271-2CrossRef

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 32:1946–1953. https://doi.org/10.1016/j.arth.2017.01.013CrossRefPubMed

Watters TS, Martin JR, Levy DL et al (2017) Porous-coated metaphyseal sleeves for severe femoral and tibial bone loss in revision TKA. J Arthroplasty 32:3468–3473. https://doi.org/10.1016/j.arth.2017.06.025CrossRefPubMed

Potter GD, Abdel MP, Lewallen DG, Hanssen AD (2016) Midterm results of porous tantalum femoral cones in revision total knee arthroplasty. J Bone Joint Surg Am 98:1286–1291. https://doi.org/10.2106/JBJS.15.00874CrossRefPubMed

Maslaris A, Layher F, Bungartz M et al (2019) Sagittal profile has a significant impact on the explantability of well-fixed cemented stems in revision knee arthroplasty: a biomechanical comparison study of five established knee implant models. Arch Orthop Trauma Surg 139:991–998. https://doi.org/10.1007/s00402-019-03160-4CrossRefPubMed

10.

Divano S, Cavagnaro L, Zanirato A et al (2018) Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature. Arch Orthop Trauma Surg 138:851–863. https://doi.org/10.1007/s00402-018-2936-7CrossRefPubMed

11.

Fink B, Mittelstädt A (2019) Treatment of periprosthetic fractures of the knee using trabecular metal cones for stabilization. Arthroplasty Today 5:159–163. https://doi.org/10.1016/j.artd.2018.10.007CrossRefPubMed

12.

Sandiford NA, Misur P, Garbuz DS et al (2017) No difference between trabecular metal cones and femoral head allografts in revision TKA: minimum 5-year followup. Clin Orthop 475:118–124. https://doi.org/10.1007/s11999-016-4898-9CrossRefPubMed

13.

Bohl DD, Brown NM, McDowell MA et al (2018) Do porous tantalum metaphyseal cones improve outcomes in revision total knee arthroplasty? J Arthroplasty 33:171–177. https://doi.org/10.1016/j.arth.2017.07.033CrossRefPubMed

14.

Wirries N, Winnecken HJ, von Lewinski G et al (2019) Osteointegrative sleeves for metaphyseal defect augmentation in revision total knee arthroplasty: clinical and radiological 5-year follow-up. J Arthroplasty. https://doi.org/10.1016/j.arth.2019.04.024CrossRefPubMed

15.

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

16.

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 34:3018–3022. https://doi.org/10.1016/j.arth.2019.06.057CrossRefPubMed

17.

Engh GA, Ammeen DJ (1998) Classification and preoperative radiographic evaluation: knee. Orthop Clin North Am 29:205–217. https://doi.org/10.1016/s0030-5898(05)70319-9CrossRefPubMed

18.

Scuderi GR, Tria AJ (2006) Knee arthroplasty handbook: techniques in total knee and revision arthroplasty. Springer Science and Business Media https://www.springer.com/gp/book/9780387307305

19.

Backstein D, Safir O, Gross A (2006) Management of bone loss: structural grafts in revision total knee arthroplasty. Clin Orthop Relat Res 446:104. https://doi.org/10.1097/01.blo.0000214426.52206.2cCrossRefPubMed

20.

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 33:3739–3745. https://doi.org/10.1016/j.arth.2018.08.026CrossRefPubMed

21.

Agarwal S, Neogi DS, Morgan-Jones R (2018) Metaphyseal sleeves in revision total knee arthroplasty: minimum seven-year follow-up study. Knee. https://doi.org/10.1016/j.knee.2018.09.010CrossRefPubMed

22.

Zanirato A, Cavagnaro L, Basso M et al (2018) Metaphyseal sleeves in total knee arthroplasty revision: complications, clinical and radiological results. A systematic review of the literature. Arch Orthop Trauma Surg 138:993–1001. https://doi.org/10.1007/s00402-018-2967-0CrossRefPubMed

23.

Klim SM, Amerstorfer F, Bernhardt GA et al (2018) Septic revision total knee arthroplasty: treatment of metaphyseal bone defects using metaphyseal sleeves. J Arthroplasty. https://doi.org/10.1016/j.arth.2018.08.017CrossRefPubMed

24.

Kim HJ, Lee O-S, Lee SH, Lee YS (2018) Comparative analysis between cone and sleeve in managing severe bone defect during revision total knee arthroplasty: a systematic review and meta-analysis. J Knee Surg 31:677–685. https://doi.org/10.1055/s-0037-1606564CrossRefPubMed

25.

Stambough JB, Haynes JA, Barrack RL, Nunley RM (2018) Acetabular wedge augments for uncontained tibial plateau defects in revision total knee arthroplasty. Arthroplasty Today 4:313–318. https://doi.org/10.1016/j.artd.2018.02.005CrossRefPubMedPubMedCentral

26.

Barnett SL, Mayer RR, Gondusky JS et al (2014) Use of stepped porous titanium metaphyseal sleeves for tibial defects in revision total knee arthroplasty: short term results. J Arthroplasty 29:1219–1224. https://doi.org/10.1016/j.arth.2013.12.026CrossRefPubMed

27.

Mortazavi SMJ, Schwartzenberger J, Austin MS et al (2010) Revision total knee arthroplasty infection: incidence and predictors. Clin Orthop 468:2052–2059. https://doi.org/10.1007/s11999-010-1308-6CrossRefPubMedPubMedCentral

Title: Medium term clinical outcomes of tibial cones in revision knee arthroplasty
Authors: Roger Erivan
Robert Tracey
Aurélien Mulliez
Guillaume Villatte
Wayne Paprosky
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keyword: Bone Defect
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2021
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03532-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Medium term clinical outcomes of tibial cones in revision knee arthroplasty

Abstract

Introduction

Patients and methods

Results

Discussion

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Discussion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2021

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Impact of the Holocaust on the outcomes of elderly patients sustaining a fragility hip fracture

Global differences in the treatment of Legg–Calvé–Perthes disease: a comprehensive review

Definition of the terms “acute” and “traumatic” in rotator cuff injuries: a systematic review and call for standardization in nomenclature

Incidence of concomitant chondral/osteochondral lesions in acute ankle fractures and their effect on clinical outcome: a systematic review and meta-analysis

Two-year radiologic assessment of the Pinnacle cup—a migration analysis with EBRA