Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 6, pp 851–863 | Cite as

Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature

  • Stefano Divano
  • Luca Cavagnaro
  • Andrea Zanirato
  • Marco Basso
  • Lamberto Felli
  • Matteo  Formica
Knee Revision Surgery



Revision knee arthroplasty is increasing, and in that case, bone loss management is still a challenging problem. In the last years, the body of literature and interest surrounding porous metal cones has grown, but few systematic evaluations of the existing evidence have been performed. The aim of our systematic review is to collect and critically analyze the available evidence about metal cones in revision knee arthroplasty especially focusing our attention on indications, results, complications, and infection rate of these promising orthopaedic devices.

Materials and methods

We performed a systematic review of the available English literature, considering the outcomes and the complications of tantalum cones. The combinations of keyword were “porous metal cones”, “knee revision”, “bone loss”, “knee arthroplasty”, “periprosthetic joint infection”, and “outcome”.


From the starting 312 papers available, 20 manuscripts were finally included. Only one included study has a control group. The main indication for metal cones is type IIb and III defects according AORI classification. Most of the papers show good clinical and radiological outcomes with low rate of complications.


The examined studies provide encouraging clinical and radiological short-to-mid-term outcomes. Clinical studies have shown a low rate of aseptic loosening, intraoperative fractures, infection rate and a lower failure rate than the previous treatment methods. Higher quality papers are needed to draw definitive conclusions about porous metal cones.


Porous metal cones Knee revision Bone loss Knee arthroplasty Periprosthetic joint infection Outcome 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Stefano Divano
    • 1
  • Luca Cavagnaro
    • 1
  • Andrea Zanirato
    • 1
  • Marco Basso
    • 1
  • Lamberto Felli
    • 1
  • Matteo  Formica
    • 1
  1. 1.U.O. Clinica Ortopedica e TraumatologicaOspedale Policlinico San Martino ISTGenoaItaly

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