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Can Tantalum Cones Provide Fixation in Complex Revision Knee Arthroplasty?

  • Symposium: Papers Presented at the Annual Meetings of The Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The best method for managing large bone defects during revision knee arthroplasty is unknown. Metaphyseal fixation using porous tantalum cones has been proposed for severe bone loss. Whether this approach achieves osseointegration with low complication rates is unclear.

Questions/purposes

We therefore asked: (1) What is the risk of infection in revision knee arthroplasty with large bone defects reconstructed with porous tantalum cones? (2) What is the rate of osseointegration with these cones? (3) What is the rate of loosening and reoperation? (4) Is knee function restored?

Methods

We retrospectively reviewed 27 patients who had 33 tantalum cones (nine femoral, 24 tibial) implanted during 27 revision knee arthroplasties. There were 14 women and 13 men with a mean age of 64.6 years. Preoperative diagnosis was reimplantation for infection in 13 knees, aseptic loosening in 10, and wear-osteolysis in four. Patients were evaluated clinically and radiographically using the score systems of the Knee Society and followed for a minimum of 2 years (mean, 3.3 years; range, 2–5.7 years).

Results

One knee with two cones was removed for infection. All but one cone showed osseointegration. One knee was revised for femoral cone and component loosening. There was one reoperation for femoral shaft fracture and one for superficial dehiscence. The mean Knee Society pain score improved from 40 points preoperatively to 79 points postoperatively. The mean function score improved from 19 points to 47 points.

Conclusions

Our observations suggest metaphyseal fixation with tantalum cones can be achieved. Longer-term followup is required to determine whether the fixation is durable.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Backstein D, Safir O, Gross A. Management of bone loss: structural grafts in revision total knee arthroplasty. Clin Orthop Relat Res. 2006;446:104–112.

    Article  PubMed  Google Scholar 

  2. Barrack RL, Jennings RW, Wolfe MW, Bertot AJ. The Coventry award: the value of preoperative aspiration before total knee revision. Clin Orthop Relat Res. 1997;345:8–16.

    Article  PubMed  Google Scholar 

  3. Bauman RD, Lewallen DG, Hanssen AD. Limitations of structural allograft in revision total knee arthroplasty. Clin Orthop Relat Res. 2009;467:818–824.

    Article  PubMed  Google Scholar 

  4. Benjamin J, Engh G, Parsley B, Donaldson T, Coon T. Morselized bone grafting of defects in revision total knee arthroplasty. Clin Orthop Relat Res. 2001;392:62–67.

    Article  PubMed  Google Scholar 

  5. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999;81:907–914.

    Article  PubMed  CAS  Google Scholar 

  6. 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;83:404–411.

    PubMed  Google Scholar 

  7. Duff GP, Lachiewicz PF, Kelley SS. Aspiration of the knee joint before revision arthroplasty. Clin Orthop Relat Res. 1996;331:132–139.

    Article  PubMed  Google Scholar 

  8. Engh GA, Ammeen DJ. Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect. 1999;48:167–175.

    PubMed  CAS  Google Scholar 

  9. Engh GA, Ammeen DJ. Use of structural allograft in revision total knee arthroplasty in knees with severe tibial bone loss. J Bone Joint Surg Am. 2007;89:2640–2647.

    Article  PubMed  Google Scholar 

  10. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.

    PubMed  Google Scholar 

  11. Findlay DM, Welldon K, Atkins GJ, Howie DW, Zannettino AC, Bobyn D. The proliferation and phenotypic expression of human osteoblasts on tantalum metal. Biomaterials. 2004;25:2215–2227.

    Article  PubMed  CAS  Google Scholar 

  12. Ghazavi MT, Stockley I, Yee G, Davis A, Gross AE. Reconstruction of massive bone defects with allograft in revision total knee arthroplasty. J Bone Joint Surg Am. 1997;79:17–25.

    Article  PubMed  CAS  Google Scholar 

  13. Hockman DE, Ammeen D, Engh GA. Augments and allografts in revision total knee arthroplasty: usage and outcome using one modular revision prosthesis. J Arthroplasty. 2005;20:35–41.

    Article  PubMed  Google Scholar 

  14. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.

    PubMed  Google Scholar 

  15. Jacobs C, Christensen CP, Berend ME. Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection. J Am Acad Orthop Surg. 2009;17:356–368.

    PubMed  Google Scholar 

  16. Long WJ, Scuderi GR. Porous tantalum cones for large metaphyseal tibial defects in revision total knee arthroplasty: a minimum 2-year follow-up. J Arthroplasty. 2009;24:1086–1092.

    Article  PubMed  Google Scholar 

  17. 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. 2008;90:78–84.

    Article  PubMed  Google Scholar 

  18. Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. Surgical technique. J Bone Joint Surg Am. 2009;91(Suppl 2):131–138.

    Article  PubMed  Google Scholar 

  19. Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RSJ, Barrack RL. Diagnosis of infected total knee: findings of a multicenter database. Clinical Orthop Relat Res. 2008;466:2628–2633

    Article  Google Scholar 

  20. Ries MD. Impacted cancellous autograft for contained bone defects in total knee arthroplasty. Am J Knee Surg. 1996;9:51–54.

    PubMed  CAS  Google Scholar 

  21. Schildhauer TA, Peter E, Muhr G, Koller M. Activation of human leukocytes on tantalum trabecular metal in comparison to commonly used orthopedic metal implant materials. J Biomed Mater Res A. 2009;88:332–341.

    PubMed  CAS  Google Scholar 

  22. Schildhauer TA, Robie B, Muhr G, Koller M. Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials. J Orthop Trauma. 2006;20:476–484.

    Article  PubMed  Google Scholar 

  23. Welldon KJ, Atkins GJ, Howie DW, Findlay DM. Primary human osteoblasts grow into porous tantalum and maintain an osteoblastic phenotype. J Biomed Mater Res A. 2008;84:691–701.

    PubMed  Google Scholar 

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Acknowledgment

We thank Dr. Tyler Steven Watters for his extensive contribution in data collection and interpretation for this study.

Author information

Authors and Affiliations

  1. Durham VA Medical Center, Durham, NC, USA

    Paul F. Lachiewicz MD

  2. Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA

    Michael P. Bolognesi MD & Robert A. Henderson MSc

  3. Chapel Hill Orthopedics Surgery & Sports Medicine, 101 Conner Drive, Suite 200, Chapel Hill, NC, 27514, USA

    Paul F. Lachiewicz MD & Elizabeth S. Soileau BSN

  4. Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA

    Thomas Parker Vail MD

Authors
  1. Paul F. Lachiewicz MD
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  2. Michael P. Bolognesi MD
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  3. Robert A. Henderson MSc
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  4. Elizabeth S. Soileau BSN
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  5. Thomas Parker Vail MD
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Corresponding author

Correspondence to Paul F. Lachiewicz MD.

Additional information

One of the institutions of the authors (Chapel Hill Orthopedics Surgery and Sports Medicine) receives research support from Zimmer, Inc. Two of the authors (PFL, MPB) are also on the Speakers’ Bureau of Zimmer, Inc.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This project was performed at the Durham VA Medical Center, Duke University Medical Center, Durham, NC, USA, and Chapel Hill Orthopedic Surgery and Sports Medicine, Chapel Hill, NC, USA.

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Lachiewicz, P.F., Bolognesi, M.P., Henderson, R.A. et al. Can Tantalum Cones Provide Fixation in Complex Revision Knee Arthroplasty?. Clin Orthop Relat Res 470, 199–204 (2012). https://doi.org/10.1007/s11999-011-1888-9

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  • DOI: https://doi.org/10.1007/s11999-011-1888-9

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