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Novel metaphyseal porous titanium cones allow favorable outcomes in revision total knee arthroplasty

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

Abstract

Introduction

Loosening and migration are common modes of aseptic failure following complex revision total knee arthroplasty (rTKA). Metaphyseal cones allow surgeons to negotiate the loss of femoral and tibial bone stock while obtaining stable bony fixation. This study examines the mid-term functional and radiographic outcomes in patients undergoing rTKA utilizing a novel metaphyseal cone system with stems of variable length and fixation methods.

Methods

This two-center retrospective study examined all patients who underwent rTKA with a novel porous, titanium tibial or femoral cone in combination with a stem of variable length and fixation who had a minimum follow-up of 2-years. Outcome analysis was separated into tibial and femoral cones as well as the stem fixation method (hybrid vs. fully cemented).

Results

Overall, 123 patients who received 156 cone implants were included (74 [60.2%] tibial only, 16 [13.0%] femoral only, and 33 [26.8%] simultaneous tibial and femoral) with a mean follow-up of 2.76 ± 0.66 years. At 2-years of follow-up the total cohort demonstrated 94.3% freedom from all-cause re-revisions, 97.6% freedom from aseptic re-revisions, and 99.4% of radiographic cone osteointegration. All-cause revision rates did not differ between stem fixation techniques in both the tibial and femoral cone groups.

Conclusion

The use of a novel porous titanium femoral and tibial metaphyseal cones combined with stems in patients with moderate to severe bone defects undergoing complex revision total knee arthroplasty confers excellent results independent of stem fixation technique.

Level of evidence

IV, case series.

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References

  1. Vasso M, Beaufils P, Cerciello S, Schiavone Panni A (2014) Bone loss following knee arthroplasty: potential treatment options. Arch Orthop Trauma Surg 134:543–553. https://doi.org/10.1007/s00402-014-1941-8

    Article  PubMed  Google Scholar 

  2. Morgan-Jones R, Oussedik SIS, Graichen H, Haddad FS (2015) Zonal fixation in revision total knee arthroplasty. Bone Joint J 97:147–149. https://doi.org/10.1302/0301-620X.97B2.34144

    Article  PubMed  Google Scholar 

  3. Ponzio DY, Austin MS (2015) Metaphyseal bone loss in revision knee arthroplasty. Curr Rev Musculoskelet Med 8:361–367. https://doi.org/10.1007/s12178-015-9291-x

    Article  PubMed  PubMed Central  Google Scholar 

  4. Malhotra R, Garg B, Kumar V (2011) Dual massive skeletal allograft in revision total knee arthroplasty. Indian J Orthop. https://doi.org/10.4103/0019-5413.82345

    Article  PubMed  PubMed Central  Google Scholar 

  5. Anderson LA, Christie M, Blackburn BE et al (2021) 3D-printed titanium metaphyseal cones in revision total knee arthroplasty with cemented and cementless stems. Bone Jt J 103:150–157. https://doi.org/10.1302/0301-620X.103B6.BJJ-2020-2504.R1

    Article  Google Scholar 

  6. Behery OA, Shing EZ, Yu Z et al (2021) Survivorship and radiographic evaluation of metaphyseal cones with short cemented stems in revision total knee arthroplasty. J Arthroplasty 37:330–335. https://doi.org/10.1016/j.arth.2021.10.027

    Article  PubMed  Google Scholar 

  7. Kamath AF, Lewallen DG, Hanssen AD (2015) Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty. J Bone Jt Surg Am 97:216–223. https://doi.org/10.2106/JBJS.N.00540

    Article  Google Scholar 

  8. Tetreault MW, Perry KI, Pagnano MW et al (2020) Excellent two-year survivorship of 3D-printed metaphyseal cones in revision total knee arthroplasty. Bone Jt J 102:107–115. https://doi.org/10.1302/0301-620X.102B6.BJJ-2019-1544.R1

    Article  Google Scholar 

  9. Kang SG, Park CH, Song SJ (2018) Stem fixation in revision total knee arthroplasty: indications, stem dimensions, and fixation methods. Knee Surg Relat Res 30:187–192. https://doi.org/10.5792/ksrr.18.019

    Article  PubMed  PubMed Central  Google Scholar 

  10. Patel AR, Barlow B, Ranawat AS (2015) Stem length in revision total knee arthroplasty. Curr Rev Musculoskelet Med 8:407–412. https://doi.org/10.1007/s12178-015-9297-4

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jacquet C, Ros F, Guy S et al (2021) Trabecular metal cones combined with short cemented stem allow favorable outcomes in aseptic revision total knee arthroplasty. J Arthroplasty 36:657–663. https://doi.org/10.1016/j.arth.2020.08.058

    Article  PubMed  Google Scholar 

  12. Denehy KM, Abhari S, Krebs VE et al (2019) Metaphyseal fixation using highly porous cones in revision total knee arthroplasty: minimum two year follow up study. J Arthroplasty 34:2439–2443. https://doi.org/10.1016/j.arth.2019.03.045

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  14. Huten D (2013) Femorotibial bone loss during revision total knee arthroplasty. Orthop Traumatol Surg Res 99:S22-33. https://doi.org/10.1016/j.otsr.2012.11.009

    Article  CAS  PubMed  Google Scholar 

  15. Ewald (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 2:2

    Google Scholar 

  16. Fehring TK, Odum S, Olekson C et al (2003) Stem fixation in revision total knee arthroplasty. Clin Orthop Relat Res 416:217–224. https://doi.org/10.1097/01.blo.0000093032.56370.4b

    Article  Google Scholar 

  17. Bottner F, Laskin R, Windsor RE, Haas SB (2006) Hybrid component fixation in revision total knee arthroplasty. Clin Orthop Relat Res 446:127–131. https://doi.org/10.1097/01.blo.0000214418.36959.c5

    Article  PubMed  Google Scholar 

  18. Wang C, Pfitzner T, von Roth P et al (2016) Fixation of stem in revision of total knee arthroplasty: cemented versus cementless—a meta-analysis. Knee Surg Sport Traumatol Arthrosc 24:3200–3211. https://doi.org/10.1007/s00167-015-3820-4

    Article  Google Scholar 

  19. Lei P, Hu R, Hu Y (2019) Bone defects in revision total knee arthroplasty and management. Orthop Surg 11:15–24. https://doi.org/10.1111/os.12425

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rodríguez-Merchán EC, Gómez-Cardero P, Encinas-Ullán CA (2021) Management of bone loss in revision total knee arthroplasty: therapeutic options and results. EFORT Open Rev 6:1073–1086. https://doi.org/10.1302/2058-5241.6.210007

    Article  PubMed  PubMed Central  Google Scholar 

  21. Erivan R, Tracey R, Mulliez A et al (2021) Medium term clinical outcomes of tibial cones in revision knee arthroplasty. Arch Orthop Trauma Surg 141:113–118. https://doi.org/10.1007/s00402-020-03532-1

    Article  PubMed  Google Scholar 

  22. Suh C, Se L, Park J, Soo S (2013) The effect of simulated knee flexion on sagittal spinal alignment: novel interpretation of spinopelvic alignment. Eur Spine J. https://doi.org/10.1007/s00586-013-2661-4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Divano S, Cavagnaro L, Zanirato A et al (2018) Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature. Arch Orthop Trauma Surg 138:851–863. https://doi.org/10.1007/s00402-018-2936-7

    Article  PubMed  Google Scholar 

  24. Chalmers BP, Malfer CM, Mayman DJ et al (2021) Early survivorship of newly designed highly porous metaphyseal tibial cones in revision total knee arthroplasty. Arthroplast Today 8:5–10. https://doi.org/10.1016/j.artd.2021.01.004

    Article  PubMed  PubMed Central  Google Scholar 

  25. Geary MB, Macknet DM, Ransone MP et al (2020) Why do revision total knee arthroplasties fail? A single-center review of 1632 revision total knees comparing historic and modern cohorts. J Arthroplasty 35:2938–2943. https://doi.org/10.1016/j.arth.2020.05.050

    Article  PubMed  Google Scholar 

  26. Angerame MR, Jennings JM, Holst DC, Dennis DA (2019) Management of bone defects in revision total knee arthroplasty with use of a stepped, porous-coated metaphyseal sleeve. JBJS Essent Surg Tech 9:e14. https://doi.org/10.2106/JBJS.ST.18.00038

    Article  PubMed  PubMed Central  Google Scholar 

  27. Brown NM, Bell JA, Jung EK et al (2015) The use of trabecular metal cones in complex primary and revision total knee arthroplasty. J Arthroplasty 30:90–93. https://doi.org/10.1016/j.arth.2015.02.048

    Article  PubMed  Google Scholar 

  28. Girerd D, Parratte S, Lunebourg A et al (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 102:429–433. https://doi.org/10.1016/j.otsr.2016.02.010

    Article  CAS  PubMed  Google Scholar 

  29. Behery OA, Shing EZ, Yu Z et al (2021) Survivorship and radiographic evaluation of metaphyseal cones with short cemented stems in revision total knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2021.10.027

    Article  PubMed  Google Scholar 

  30. Hernandez NM, Hinton ZW, Wu CJ et al (2021) Mid-term results of tibial cones. Bone Joint J 103:158–164. https://doi.org/10.1302/0301-620X.103B6.BJJ-2020-1934.R1

    Article  PubMed  Google Scholar 

  31. Kosse NM, van Hellemondt GG, Wymenga AB, Heesterbeek PJC (2017) Comparable stability of cemented vs press-fit placed stems in revision total knee arthroplasty with mild to moderate bone loss: 6.5-year results from a randomized controlled trial with radiostereometric analysis. J Arthroplasty 32:197–201. https://doi.org/10.1016/j.arth.2016.06.003

    Article  PubMed  Google Scholar 

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Funding

No funding was provided for this study.

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Authors and Affiliations

  1. Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA

    Ittai Shichman, Christian Oakley, Joshua Rozell, Scott Marwin & Ran Schwarzkopf

  2. Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Ittai Shichman

  3. Department of Orthopedic Surgery, Sint Maartensklinek, Ubbergen, Gelderland, The Netherlands

    Jore H. Willems & Gijs G. van Hellemondt

  4. Research Department, Sint Maartensklinek, Ubbergen, Gelderland, The Netherlands

    Petra Heesterbeek

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  1. Ittai Shichman
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Corresponding author

Correspondence to Ran Schwarzkopf.

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Conflict of interest

I.S, C.O, J.W, P.H J.R have nothing to disclose. G.VH reports being a paid consultant for Smith&Nephew. S.M reports being a paid consultant for Zimmer and Intelijoint. R.S reports IP royalties from Smith & Nephew, being paid consultant for Smith & Nephew, Intelijoint, have stock options from Intelijoint, Gauss Surgical and receives research support from Smith & Nephew anddIntelijoint.

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The present study was exempt from human-subjects review by our Institutional Review Board (IRB).

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Shichman, I., Oakley, C., Willems, J.H. et al. Novel metaphyseal porous titanium cones allow favorable outcomes in revision total knee arthroplasty. Arch Orthop Trauma Surg 143, 1537–1547 (2023). https://doi.org/10.1007/s00402-022-04645-5

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