Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature
- 48 Downloads
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.
KeywordsPorous 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.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 3.Carrega G, Bartolacci V, Burastero G, Casalino Finocchio G, Grappiolo G, Ronca A, Salomone C, Riccio G (2011) Surgery-related infections following arthoplasty: a prospective survey in a tertiary-care center. Minerva Ortopedica e Traumatologica 62(1):1–8Google Scholar
- 7.Burastero G, Sessarego N, Grappiolo G, Castellazzo C, Castello S, Pitto A, Cittadini G, Podesta M, Bovio G, Peresi M, Fulcheri E, Frassoni F (2007) L. Spotorno Association of ex-vivo expanded human mesenchymal stem cellsand rhBMP-7 is highly effective in treating critical femoral defect in rats. J Orthop Traumatol 8(1):49–54CrossRefPubMedCentralGoogle Scholar
- 9.Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF (2007) Rotating hinged total knee replacement: use with caution. J Bone Jt Surg Am 89:1735–1741Google Scholar
- 10.OCEBM Levels of Evidence Working Group*. The Oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653
- 18.Villanueva-Martínez M, De la Torre-Escudero B, Rojo-Manaute JM, Ríos-Luna A, Chana-Rodriguez F (2013) Tantalum cones in revision total knee arthroplasty. A promising short-term result with 29 cones in 21 patients. J Arthroplasty 28(6):988–993. https://doi.org/10.1016/j.arth.2012.09.003 (Epub 2013 Feb 13) CrossRefPubMedGoogle Scholar
- 21.Derome P, Sternheim A, Backstein D, Malo M (2014) Treatment of large bone defects with trabecular metal cones in revision total knee arthroplasty: short term clinical and radiographic outcomes. J Arthroplasty 29(1):122–126. https://doi.org/10.1016/j.arth.2013.04.033 (Epub 2013 May 20) CrossRefPubMedGoogle Scholar
- 23.Jensen CL, Winther N, Schrøder HM, Petersen MM (2014) Outcome of revision total knee arthroplasty with the use of trabecular metal cone for reconstruction of severe bone loss at the proximal tibia. Knee 21(6):1233–1237. https://doi.org/10.1016/j.knee.2014.08.017 (Epub 2014 Sep 10) CrossRefPubMedGoogle Scholar
- 29.Girerd D, Parratte S, Lunebourg A, Boureau F, Ollivier M, Pasquier G, Putman S, Migaud H, Argenson JN (2016) 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 102(4):429–433. https://doi.org/10.1016/j.otsr.2016.02.010 (Epub 2016 Apr 1) CrossRefPubMedGoogle Scholar