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A prospective study on outcome of patient-specific cones in revision knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Cones are known to be good substitutes for metaphyseal and diaphyseal bone loss during revision total knee arthroplasty (RTKA). Often the off-the-shelf cones do not fit to the individual patient’s anatomy. New 3D-printing additive technologies allow to develop patient-specific cones. The aim of this prospective study was to describe their outcome.

Methods

From 2017 until 2020, 35 patient-specific titanium cones (15 femoral and 20 tibial) were implanted during 31 RTKAs (45% varus–valgus constrained implants and 55% rotating hinges). Clinical outcome was evaluated using KSS, WOMAC and FJS-12 scoring systems at 12 and 24 months. No patients were lost for follow-up.

Results

In all cases, there were no technical difficulties in adapting the cones to both the host bone and the revision implant. By the time of performing data analysis (January 2021), none of the 31 patients needed revision surgery for any reason. At 12 months of follow-up, the mean values of scores for knee function improved significantly from baseline (p < 0.01): KSS—103.00 (min 100–max 111, SD 5.35), WOMAC—16.5 (min 9–max 24, SD 6.45), FJS-12—61.60 (min 52–max 76, SD 9.20). At 24 months, the trend towards improvement of functional results continued but did not reached statistical significance comparing to 12 months: KSS was 105.92 (min 95–max 155, SD 16.18), WOMAC—14.07 (min 0–max 42, SD 12.42), FJS-12—83.78 (min 65–max 97, SD 09.64). Radiographic signs of osteointegration were detected within the first 6 month after surgery in all cases. Loosening of femoral or tibial components as well as peri-prosthetic infection was not observed in any of the patients during the follow-up.

Conclusion

The original additive technology for designing and producing patient-specific metaphyseal and diaphyseal cones with different porosity zones for extensive femoral and tibial bone defects in RTKA is precise and clinically effective solution, at least in the short term. It could be a valid alternative to “off-the-shelf” cones or sleeves as well as structural allografts and even mega-prosthesis, but a longer follow-up period is required to assess its medium- and long-term reliability.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

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Authors and Affiliations

  1. Orthopedic Department N 17, Vreden National Medical Research Center of Traumatology and Orthopedics of the Ministry of Health of Russian Federation, 8 Akademika Baykova str., Saint Petersburg, 195427, Russian Federation

    Alexander A. Cherny & Nikolai N. Kornilov

  2. Orthopedic Department N 19, Vreden National Medical Research Center of Traumatology and Orthopedics of the Ministry of Health of Russian Federation, Saint Petersburg, Russian Federation

    Anton N. Kovalenko

  3. Orthopedic Department N 10, Vreden National Medical Research Center of Traumatology and Orthopedics of the Ministry of Health of Russian Federation, Saint Petersburg, Russian Federation

    Taras A. Kulyaba

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  1. Alexander A. Cherny
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  4. Nikolai N. Kornilov
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Correspondence to Alexander A. Cherny.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethics approval

The study was approved by Scientific Council at authors institution. According to the standard operating procedures of Local Ethic Committee, the approval of this study was not necessary because the clinical usage of 3D-printed implants was earlier permitted by Ministry of Health. Informed written consent was printed and obtained from all 31 patients.

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Cherny, A.A., Kovalenko, A.N., Kulyaba, T.A. et al. A prospective study on outcome of patient-specific cones in revision knee arthroplasty. Arch Orthop Trauma Surg 141, 2277–2286 (2021). https://doi.org/10.1007/s00402-021-04047-z

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  • DOI: https://doi.org/10.1007/s00402-021-04047-z

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