The Use of Trabecular Metal Cones for the Management of Severe Bone Defects in Revision Total Knee Replacement
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Published:
Aug 19, 2021
Keywords:
Revision, total knee replacement, bone defects, knee, trabecular metal cones
Main Article Content
Abstract
Introduction: Major bone defects represent a challenge during revision total knee arthroplasty (TKA) and there is still considerable debate about the best therapeutic option. The purpose of this study was to retrospectively assess the osseointegration rate of trabecular metal cones in revision TKA with severe bone defects. The secondary purpose was to evaluate the functional outcomes and complication and reoperation rates.
Materials and Methods: A single-center, retrospective cohort including all consecutive cases of revision TKA using trabecular metal cones. All patients with a minimum 2-year follow-up were included in the study. Reasons for revision, number of previous surgeries, type of bone defect, and number and type of trabecular cones used were evaluated. Clinical and radiological outcomes were also analyzed as well as complications rates.
Results: 35 patients (49 cones) were evaluated with a mean follow-up of 32.1 months (24-62). Most defects were localized in the tibia and were classified as AORI type 3. The rate of osseointegration of the cones was 94%; the complication rate, 20%; and the reoperation rate, 8.5%. The mean KSS increased from 39 preoperatively to 71 at the last follow-up, and the mean VAS from 8 to 2.5.
Conclusion: The excellent osseointegration rate (94%), added to the good clinical outcomes, position the trabecular metal cones as an alternative to treat severe bone defects.
Materials and Methods: A single-center, retrospective cohort including all consecutive cases of revision TKA using trabecular metal cones. All patients with a minimum 2-year follow-up were included in the study. Reasons for revision, number of previous surgeries, type of bone defect, and number and type of trabecular cones used were evaluated. Clinical and radiological outcomes were also analyzed as well as complications rates.
Results: 35 patients (49 cones) were evaluated with a mean follow-up of 32.1 months (24-62). Most defects were localized in the tibia and were classified as AORI type 3. The rate of osseointegration of the cones was 94%; the complication rate, 20%; and the reoperation rate, 8.5%. The mean KSS increased from 39 preoperatively to 71 at the last follow-up, and the mean VAS from 8 to 2.5.
Conclusion: The excellent osseointegration rate (94%), added to the good clinical outcomes, position the trabecular metal cones as an alternative to treat severe bone defects.
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How to Cite
García-Mansilla, I., Costantini, J., Nicolino, T., Astoul Bonorino , J., & Carbó, L. (2021). The Use of Trabecular Metal Cones for the Management of Severe Bone Defects in Revision Total Knee Replacement. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 483-492. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1390
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Clinical Research
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11. Jacquet C, Ros F, Guy S, Parratte S, Ollivier M, Argenson J-N. Trabecular metal cones combined with short
cemented stem allow favorable outcomes in aseptic revision total knee arthroplasty. J Arthroplasty 2021;36(2):657-63. https://doi.org/10.1016/j.arth.2020.08.058
12. Roach RP, Clair AJ, Behery OA, Thakkar SC, Iorio R, Deshmukh AJ. Aseptic loosening of porous metaphyseal
sleeves and tantalum cones in revision total knee arthroplasty: a systematic review. J Knee Surg 2020 Feb 19.
https://doi.org/10.1055/s-0040-1701434
13. Kim E, Patel N, Chughtai M, Elmallah RDK, Delanois RE, Harwin SF, et al. Tantalum cones in revision total knee
arthroplasty. J Knee Surg 2016;29(08):621-6. https://doi.org/10.1055/s-0036-1593370
14. Brown NM, Bell JA, Jung EK, Sporer SM, Paprosky WG, Levine BR. The use of trabecular metal cones in complex primary and revision total knee arthroplasty. J Arthroplasty 2015;30(9):90-3. https://doi.org/10.1016/j.arth.2015.02.048
15. De Martino I, De Santis V, Sculco PK, D’Apolito R, Assini JB, Gasparini G. Tantalum cones provide durable midterm fixation in revision TKA. Clin Orthop Relat Res 2015;473(10):3176-82. https://doi.org/10.1007/s11999-015-4338-2
16. Abdelaziz H, Jaramillo R, Gehrke T, Ohlmeier M, Citak M. Clinical survivorship of aseptic revision total
knee arthroplasty using hinged knees and tantalum cones at minimum 10-year follow-up. J Arthroplasty
2019;34(12):3018-22. https://doi.org/10.1016/j.arth.2019.06.057
17. Abdelaziz H, Biewald P, Anastasiadis Z, Haasper C, Gehrke T, Hawi N, et al. Midterm results after tantalum cones in 1-stage knee exchange for periprosthetic joint infection: a single-center study. J Arthroplasty 2020;35(4):1084-9. https://doi.org/10.1016/j.arth.2019.11.016
18. Burastero G, Cavagnaro L, Chiarlone F, Alessio-Mazzola M, Carrega G, Felli L. The use of tantalum metaphyseal cones for the management of severe bone defects in septic knee revision. J Arthroplasty 2018;33(12):3739-45. https://doi.org/10.1016/j.arth.2018.08.026
19. Potter GD, Abdel MP, Lewallen DG, Hanssen AD. Midterm results of porous tantalum femoral cones in revision total knee arthroplasty: J Bone Joint Surg 2016;98(15):1286-91. https://doi.org/10.2106/JBJS.15.00874
20. Girerd D, Parratte S, Lunebourg A, Boureau F, Ollivier M, Pasquier G, et al. Total knee arthroplasty revision with trabecular tantalum cones: Preliminary retrospective study of 51 patients from two centres with a minimal 2-year follow-up. Orthop Traumatol Surg Res 2016;102(4):429-33. https://doi.org/10.1016/j.otsr.2016.02.010
21. Kamath AF, Lewallen DG, Hanssen AD. Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. J Bone Joint Surg Am 2015;97(3):216-23.
https://doi.org/10.2106/JBJS.N.00540
22. Ponzio DY, Austin MS. Metaphyseal bone loss in revision knee arthroplasty. Curr Rev Musculoskelet Med
2015;8(4):361-7. https://doi.org/10.1007/s12178-015-9291-x
23. Beckmann NA, Mueller S, Gondan M, Jaeger S, Reiner T, Bitsch RG. Treatment of severe bone defects during
revision total knee arthroplasty with structural allografts and porous metal cones—A systematic review. J
Arthroplasty 2015;30(2):249-53. https://doi.org/10.1016/j.arth.2014.09.016
24. Lotke PA, Carolan GF, Puri N. Impaction grafting for bone defects in revision total knee arthroplasty. Clin Orthop 2006;446:99-103. https://doi.org/10.1097/01.blo.0000214414.06464.00
25. Hilgen V, Citak M, Vettorazzi E, Haasper C, Day K, Amling M, et al. 10-year results following impaction bone
grafting of major bone defects in 29 rotational and hinged knee revision arthroplasties: A follow-up of a previous
report. Acta Orthop 2013;84(4):387-91. https://doi.org/10.3109/17453674.2013.814012
26. Clatworthy MG, Ballance J, Brick GW, Chandler HP, Gross AE. The use of structural allograft for uncontained
defects in revision total knee arthroplasty: a minimum five-year review. J Bone Joint Surg Am 2001;83(3):404-11.
https://doi.org/10.2106/00004623-200103000-00013
27. Panni AS, Vasso M, Cerciello S. Modular augmentation in revision total knee arthroplasty. Knee Surg Sports
Traumatol Arthrosc 2013;21(12):2837-43. https://doi.org/10.1007/s00167-012-2258-1
1998;29(2):205-17. https://doi.org/10.1016/S0030-5898(05)70319-9
2. Lei P, Hu R, Hu Y. Bone defects in revision total knee arthroplasty and management: bone defects in revision TKA. Orthop Surg 2019;11(1):15-24. https://doi.org/10.1111/os.12425
3. Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 2016;98-B(1_Supple_A):120-4.
https://doi.org/10.1302/0301-620X.98B1.36345
4. Haidukewych GJ, Hanssen A, Dickey Jones R. Metaphyseal fixation in revision total knee arthroplasty: indications and techniques: Am Acad Orthop Surg 2011;19(6):311-8. https://doi.org/10.5435/00124635-201106000-00001
5. Ayerza M, Yacuzzi C, Costa Paz M, Aponte Tinao L, Makino A, Múscolo DL. Cirugía de revisión protésica en
pacientes con defectos óseos masivos de la rodilla. Rev Artrosc 2007;14(1):34-9. Disponible en: https://www.
revistaartroscopia.com/ediciones-anteriores/2007/volumen-14-numero-1/35-volumen-05-numero-1/volumen-14-numero-1/618-cirugia-de-revision-protesica-en-pacientes-con-defectos-oseos-masivos-de-la-rodilla
6. Bauman RD, Lewallen DG, Hanssen AD. Limitations of structural allograft in revision total knee arthroplasty. Clin Orthop 2009;467(3):818-24. https://doi.org/10.1007/s11999-008-0679-4
7. Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement: J Bone Joint Surg Am 2009;91(Suppl 2):131-8. https://doi.org/10.2106/JBJS.H.01061
8. Boureau F, Putman S, Arnould A, Dereudre G, Migaud H, Pasquier G. Tantalum cones and bone defects in revision total knee arthroplasty. Orthop Traumatol Surg Res 2015;101(2):251-5. https://doi.org/10.1016/j.otsr.2014.11.020
9. Divano S, Cavagnaro L, Zanirato A, Basso M, Felli L, Formica M. Porous metal cones: gold standard for massive
bone loss in complex revision knee arthroplasty? A systematic review of current literature. Arch Orthop Trauma
Surg 2018;138(6):851-63. https://doi.org/10.1007/s00402-018-2936-7
10. Bonanzinga T, Gehrke T, Zahar A, Zaffagnini S, Marcacci M, Haasper C. Are trabecular metal cones a valid option to treat metaphyseal bone defects in complex primary and revision knee arthroplasty? Joints 2018;06(01):058-64. https://doi.org/10.1055/s-0037-1608950
11. Jacquet C, Ros F, Guy S, Parratte S, Ollivier M, Argenson J-N. Trabecular metal cones combined with short
cemented stem allow favorable outcomes in aseptic revision total knee arthroplasty. J Arthroplasty 2021;36(2):657-63. https://doi.org/10.1016/j.arth.2020.08.058
12. Roach RP, Clair AJ, Behery OA, Thakkar SC, Iorio R, Deshmukh AJ. Aseptic loosening of porous metaphyseal
sleeves and tantalum cones in revision total knee arthroplasty: a systematic review. J Knee Surg 2020 Feb 19.
https://doi.org/10.1055/s-0040-1701434
13. Kim E, Patel N, Chughtai M, Elmallah RDK, Delanois RE, Harwin SF, et al. Tantalum cones in revision total knee
arthroplasty. J Knee Surg 2016;29(08):621-6. https://doi.org/10.1055/s-0036-1593370
14. Brown NM, Bell JA, Jung EK, Sporer SM, Paprosky WG, Levine BR. The use of trabecular metal cones in complex primary and revision total knee arthroplasty. J Arthroplasty 2015;30(9):90-3. https://doi.org/10.1016/j.arth.2015.02.048
15. De Martino I, De Santis V, Sculco PK, D’Apolito R, Assini JB, Gasparini G. Tantalum cones provide durable midterm fixation in revision TKA. Clin Orthop Relat Res 2015;473(10):3176-82. https://doi.org/10.1007/s11999-015-4338-2
16. Abdelaziz H, Jaramillo R, Gehrke T, Ohlmeier M, Citak M. Clinical survivorship of aseptic revision total
knee arthroplasty using hinged knees and tantalum cones at minimum 10-year follow-up. J Arthroplasty
2019;34(12):3018-22. https://doi.org/10.1016/j.arth.2019.06.057
17. Abdelaziz H, Biewald P, Anastasiadis Z, Haasper C, Gehrke T, Hawi N, et al. Midterm results after tantalum cones in 1-stage knee exchange for periprosthetic joint infection: a single-center study. J Arthroplasty 2020;35(4):1084-9. https://doi.org/10.1016/j.arth.2019.11.016
18. Burastero G, Cavagnaro L, Chiarlone F, Alessio-Mazzola M, Carrega G, Felli L. The use of tantalum metaphyseal cones for the management of severe bone defects in septic knee revision. J Arthroplasty 2018;33(12):3739-45. https://doi.org/10.1016/j.arth.2018.08.026
19. Potter GD, Abdel MP, Lewallen DG, Hanssen AD. Midterm results of porous tantalum femoral cones in revision total knee arthroplasty: J Bone Joint Surg 2016;98(15):1286-91. https://doi.org/10.2106/JBJS.15.00874
20. Girerd D, Parratte S, Lunebourg A, Boureau F, Ollivier M, Pasquier G, et al. Total knee arthroplasty revision with trabecular tantalum cones: Preliminary retrospective study of 51 patients from two centres with a minimal 2-year follow-up. Orthop Traumatol Surg Res 2016;102(4):429-33. https://doi.org/10.1016/j.otsr.2016.02.010
21. Kamath AF, Lewallen DG, Hanssen AD. Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. J Bone Joint Surg Am 2015;97(3):216-23.
https://doi.org/10.2106/JBJS.N.00540
22. Ponzio DY, Austin MS. Metaphyseal bone loss in revision knee arthroplasty. Curr Rev Musculoskelet Med
2015;8(4):361-7. https://doi.org/10.1007/s12178-015-9291-x
23. Beckmann NA, Mueller S, Gondan M, Jaeger S, Reiner T, Bitsch RG. Treatment of severe bone defects during
revision total knee arthroplasty with structural allografts and porous metal cones—A systematic review. J
Arthroplasty 2015;30(2):249-53. https://doi.org/10.1016/j.arth.2014.09.016
24. Lotke PA, Carolan GF, Puri N. Impaction grafting for bone defects in revision total knee arthroplasty. Clin Orthop 2006;446:99-103. https://doi.org/10.1097/01.blo.0000214414.06464.00
25. Hilgen V, Citak M, Vettorazzi E, Haasper C, Day K, Amling M, et al. 10-year results following impaction bone
grafting of major bone defects in 29 rotational and hinged knee revision arthroplasties: A follow-up of a previous
report. Acta Orthop 2013;84(4):387-91. https://doi.org/10.3109/17453674.2013.814012
26. Clatworthy MG, Ballance J, Brick GW, Chandler HP, Gross AE. The use of structural allograft for uncontained
defects in revision total knee arthroplasty: a minimum five-year review. J Bone Joint Surg Am 2001;83(3):404-11.
https://doi.org/10.2106/00004623-200103000-00013
27. Panni AS, Vasso M, Cerciello S. Modular augmentation in revision total knee arthroplasty. Knee Surg Sports
Traumatol Arthrosc 2013;21(12):2837-43. https://doi.org/10.1007/s00167-012-2258-1