Elsevier

The Journal of Arthroplasty

Volume 28, Issue 9, October 2013, Pages 1556-1560
The Journal of Arthroplasty

Three-Year Follow Up Utilizing Tantal Cones in Revision Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2013.01.028Get rights and content

Abstract

There still is no consensus on the treatment of choice in revision knee arthroplasty associated with severe femoral and/or tibial bone loss. A total of 44 patients underwent revision knee arthroplasty procedures using porous tantalum cones (TM cones) to reconstruct tibial and/or femoral bone defects. At latest follow up after 37 months (32–48), 38 patients remained in the study. Tibial and femoral bone loss was categorized according to the AORI-Classification. The average preoperative KSS improved from 34 (range, 6–90) to 63 points (range, 7–90 points). The VAS improved from 7.5 to 4.8. Two patients required a re-revision due to aseptic loosening. There was no correlation between the different types of knee prosthesis implanted. Our study shows favourable clinical and radiological outcomes using TM cones in managing significant bone loss in revision total knee surgery.

Section snippets

Materials and Methods

This study was approved by the institutional review board. A total of 44 patients underwent revision knee arthroplasty procedures using TM cones to reconstruct tibial and/or femoral bone defects. From those 44 patients, 25 were females and 19 males with an average age of 72 years (range 44–85 years). The procedures were performed from 2007 to 2009 in our institution. At latest follow up, 38 patients remained in the study, five patients were lost to follow-up and one patient past away.

The 38

Results

The average preoperative flexion of the 38 patients was 84° (range 16° to 120°). At the time of latest follow-up at 37 month (range 35–42 month), the range of motion had improved to an average flexion of 100° (range 80° to 130°). Preoperatively, 4 patients had an extension lag of < 5°, 2 patients with 5-10° and one patient with a 15° extension lag. At the time of latest follow-up all 38 patients achieved full extension except one patient who had a residual extension lag of 5°.

According to the AORI

Discussion

Managing bone loss in revision total knee arthroplasty can be compounded by several challenges and pitfalls. Management of bone loss depends on the size and location of the deficit and the patient’s age, activity, and life expectancy.

TM cones are a valid option to the management of massive bone loss. These augments can provide structural support in patients for whom a custom prosthesis or large structural allograft would have been necessary 6., 8., 10., 11., 12., 13., 14., 15., 16., 17..

Highly

References (35)

  • R.E. Jones et al.

    Total knee arthroplasty using the S-ROM mobile-bearing hinge prosthesis

    J Arthroplasty

    (2001)
  • J.H. Davies et al.

    Trabecular metal used for major bone loss in acetabular hip revision

    J Arthroplasty

    (2011)
  • T. Dixon et al.

    Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need

    Ann Rheum Dis

    (2004)
  • S. Kurtz et al.

    Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030

    J Bone Joint Surg Am

    (2007)
  • D.J. Jacofsky et al.

    Revision total knee arthroplasty: what the practicing orthopaedic surgeon needs to know

    J Bone Joint Surg Am

    (2010)
  • H.C. Schmitz et al.

    One-stage revision of knee endoprosthesis due to periprosthetic infection and Klippel-Trenaunay syndrome

    Orthopade

    (2011)
  • C. Haasper et al.

    Revision of unconstrained total knee arthroplasty—a technical analysis

    Z Orthop Unfall

    (2012)
  • J.L. Bush et al.

    Management of bone loss in revision total knee arthroplasty

    Clin Orthop Relat Res

    (2006)
  • G.A. Engh et al.

    Epidemiology of osteolysis: backside implant wear

    Instr Course Lect

    (2004)
  • G.A. Engh et al.

    Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction

    Instr Course Lect

    (1999)
  • J.H. Lonner et al.

    Impaction grafting and wire mesh for uncontained defects in revision knee arthroplasty

    Clin Orthop Relat Res

    (2002)
  • A.S. Panni et al.

    Modular augmentation in revision total knee arthroplasty

    Knee Surg Sports Traumatol Arthrosc

    (2012)
  • C.S. Radnay et al.

    Management of bone loss: augments, cones, offset stems

    Clin Orthop Relat Res

    (2006)
  • A.D. Toms et al.

    Impaction bone-grafting in revision joint replacement surgery

    J Bone Joint Surg Am

    (2004)
  • P.J. Tsahakis et al.

    Technique and results of allograft reconstruction in revision total knee arthroplasty

    Clin Orthop Relat Res

    (1994)
  • A.E. Pour et al.

    Rotating hinged total knee replacement: use with caution

    J Bone Joint Surg Am

    (2007)
  • B.D. Springer et al.

    The kinematic rotating hinge prosthesis for complex knee arthroplasty

    Clin Orthop Relat Res

    (2001)
  • Cited by (63)

    • Reconstruction of Proximal Metaphyseal Femoral Defects Using Trabecular Metal Augments in Revision Total Hip Arthroplasty

      2021, Arthroplasty Today
      Citation Excerpt :

      However, none of these strategies have completely eliminated problems with fixation in patients with severe loss of proximal femoral bone stock. Porous metal cones such as tantalum or titanium alloy constructs have been successfully used in revision arthroplasty [10,13,16,17]. The high coefficient of friction vs cancellous bone is responsible for its initial fixation [27].

    • Midterm Outcomes of Tantalum Metal Cones for Severe Bone Loss in Complex Primary and Revision Total Knee Arthroplasty

      2021, Arthroplasty Today
      Citation Excerpt :

      The intrinsic porous nature of the TM cone has been shown to have some resistance to bacterial adherence and infection compared with other materials [2,9,10]. Multiple studies have shown that TM cones provide stable fixation and rotational stability in the treatment of severe bone deficiencies in revision TKAs in the short-term with documented osteointegration [10-17]. However, a longer follow-up is needed to determine the durability of these reconstructions.

    • Other metallic alloys: Tantalum-based materials for biomedical applications

      2021, Structural Biomaterials: Properties, Characteristics, and Selection
    View all citing articles on Scopus

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.01.028.

    1

    Hans-Christian R. Schmitz and Wolfgang Klauser contributed equally to this work.

    View full text