Elsevier

The Journal of Arthroplasty

Volume 24, Issue 7, October 2009, Pages 1086-1092
The Journal of Arthroplasty

Porous Tantalum Cones for Large Metaphyseal Tibial Defects in Revision Total Knee Arthroplasty: A Minimum 2-Year Follow-up

https://doi.org/10.1016/j.arth.2008.08.011Get rights and content

Abstract

Sixteen cases of revision total knee arthroplasty requiring the use of porous tantalum tibial cones for 2 T2A, 3 T2B, 4 T3A, and 7 T3B tibial bone defects (Anderson Orthopaedic Research Institute classification) after 13 cases of aseptic loosening and 3 cases of staged reimplantation for infection were reviewed. At an average 31 months (24-38), no patients were lost to follow-up. There were 2 cases of recurrent sepsis requiring removal of a well-fixed cone. In the remaining 14 cases, the reconstructions were functioning well with no reoperations. Radiographs demonstrated reestablishment of the joint line, neutral mechanical axis (average, 5.4° of valgus), and signs of stable osteointegration into the cones. Good short-term results were achieved in complex revisions, with these new reconstructive tools.

Section snippets

Materials and Methods

Institutional review board approval was obtained for this retrospective review. All patients undergoing revision knee reconstruction for any reason, which required the use of a porous tantalum cone for tibial reconstruction (Fig. 1), were included in this study. All cases were performed by the senior surgeon. These cases represent a consecutive series of patients as porous tantalum cones were used for all cases when massive tibial defects were encountered. In no cases were other techniques such

Demographics

Sixteen revision procedures were performed on 15 patients. Average patient age at surgery was 66.1 years (range, 48-83 years). There were 8 females (1 case bilateral) and 7 males. Seven cases involved left knees and 9 right knees. The diagnosis was aseptic loosening in 13 cases and staged reimplantation after infection in 3 cases.

Surgical Data

Approaches included 15 medial parapatellar and 1 midline (associated with the extensor allograft). A quadriceps snip was required in 5 cases, and in 2 of those, a

Discussion

Large tibial bone defects present a challenging reconstructive problem. Traditionally, lesions have been treated with bone in the form of bulk allograft or impaction grafting 3, 4, 5, 6, 7, 8, 9, 10, modular tumor or custom components 11, 12, or allograft-prosthesis composites 13, 14. All of these techniques have been shown to be durable in midterm outcomes, but concerns exist for a number of reasons, including disease transmission; resorption, fracture, or immune reaction to allograft; the

Acknowledgment

The authors would like to acknowledge the assistance of Dr Henrik Bo Pedersen in manuscript and figure preparation.

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      In 12 cases, (60%) no pain was reported during walking or normal activities of daily living, in 3 cases (15%) was reported a mild-occasional pain, in 3 cases (15%) a mild pain that required analgesics to be controlled and in 2 cases (10%) a moderate pain during walking more than 100 meters not always controlled with analgesics. Porous tantalum cones have been widely considered a valid option in the management of severe bone loss in revision TKA, supported by numerous studies with promising 2- to 6-year (mean, 3.5 years) results [16–21,25–31,40]. Byttebier et al [41], recently performed of a metaanalysis the outcomes of different reconstruction options in revision TKA reporting a mid-term survivorship (5 to 10 years) of 546 porous metal cones of 89%.

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