Survivorship and Radiographic Evaluation of Metaphyseal Cones With Short Cemented Stems in Revision Total Knee Arthroplasty

Published:November 03, 2021DOI:https://doi.org/10.1016/j.arth.2021.10.027

      Abstract

      Background

      The purpose of this study is to evaluate the survivorship and radiographic outcomes of a single design of metaphyseal cone used in conjunction with short cemented stems.

      Methods

      A retrospective analysis was conducted of revision total knee arthroplasty (rTKA) patients (June 2015 to December 2017) using porous titanium femoral or tibial cones in conjunction with short cemented stems (50-75 mm). Minimum follow-up was 2 years. Survivorship, complications, and a modified Knee Society Radiographic score were analyzed.

      Results

      Forty-nine rTKAs were included in the study (12 femoral cones, 48 tibial cones). Varus-valgus constraint was used in 28 (57%) and a hinged bearing was used in 3 (6%) of these constructs. The majority were index rTKAs of primary components (86%), performed for aseptic loosening (51%) and reimplantation following staged treatment for infection (37%). Median follow-up was 39 months (range 25-58). Using a modified Knee Society Radiographic score, all constructs were classified as stable. Postoperatively, 4 rTKAs were complicated by recurrent infection (8%), periprosthetic fracture 2 (4%), and superficial wound infection 1 (2%). Seven rTKAs (14%) required reoperation. The majority of reoperations (4 rTKAs) were debridement and irrigation with implant retention for infection. Metaphyseal cone constructs with short cemented stems demonstrated 100% survivorship free of revision for aseptic loosening without evidence of radiographic loosening in any case.

      Conclusion

      Our results demonstrate excellent outcomes with the use of metaphyseal cones with short cemented stems at mid-term follow-up. This construct avoids the use of long-stem fixation with the associated extraction difficulty, end of stem pain, and potential for malposition at the joint line.

      Level of Evidence

      IV, Case Series.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kurtz S.M.
        • Ong K.L.
        • Lau E.
        • Bozic K.J.
        Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.
        J Bone Jt Surg Am Vol. 2014; 96: 624-630
        • Kurtz S.
        • Ong K.
        • Lau E.
        • Mowat F.
        • Halpern M.
        Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.
        J Bone Jt Surg Am Vol. 2007; 89: 780-785
        • Roach R.P.
        • Clair A.J.
        • Behery O.A.
        • Thakkar S.C.
        • Iorio R.
        • Deshmukh A.J.
        Aseptic loosening of porous metaphyseal sleeves and tantalum cones in revision total knee arthroplasty: a systematic review.
        J Knee Surg. 2020;
        • Haidukewych G.J.
        • Hanssen A.
        • Jones R.D.
        Metaphyseal fixation in revision total knee arthroplasty: indications and techniques.
        J Am Acad Orthopaedic Surg. 2011; 19: 311-318
        • Chalmers B.P.
        • Malfer C.M.
        • Mayman D.J.
        • Westrich G.H.
        • Sculco P.K.
        • Bostrom M.P.
        • et al.
        Early survivorship of Newly designed highly porous metaphyseal tibial cones in revision total knee arthroplasty.
        Arthroplasty Today. 2021; 8: 5-10
        • Potter 3rd, G.D.
        • Abdel M.P.
        • Lewallen D.G.
        • Hanssen A.D.
        Midterm results of porous tantalum femoral cones in revision total knee arthroplasty.
        J Bone Jt Surg Am Vol. 2016; 98: 1286-1291
        • Kamath A.F.
        • Lewallen D.G.
        • Hanssen A.D.
        Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up.
        J Bone Jt Surg Am Vol. 2015; 97: 216-223
        • Jacquet C.
        • Ros F.
        • Guy S.
        • Parratte S.
        • Ollivier M.
        • Argenson J.N.
        Trabecular metal cones Combined with short cemented stem allow favorable outcomes in aseptic revision total knee arthroplasty.
        J Arthroplasty. 2021; 36: 657-663
        • Tetreault M.W.
        • Perry K.I.
        • Pagnano M.W.
        • Hanssen A.D.
        • Abdel M.P.
        Excellent two-year survivorship of 3D-printed metaphyseal cones in revision total knee arthroplasty.
        Bone Jt J. 2020; 102-B: 107-115
        • Anderson L.A.
        • Christie M.
        • Blackburn B.E.
        • Mahan C.
        • Earl C.
        • Pelt C.E.
        • et al.
        3D-printed titanium metaphyseal cones in revision total knee arthroplasty with cemented and cementless stems.
        Bone Jt J. 2021; 103-B: 150-157
        • Engh G.A.
        • Ammeen D.J.
        Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction.
        Instruct Course Lect. 1999; 48: 167-175
        • Ewald F.C.
        The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system.
        Clin Orthopaedics Relat Res. 1989; : 9-12
        • Fehring T.K.
        • Odum S.
        • Olekson C.
        • Griffin W.L.
        • Mason J.B.
        • McCoy T.H.
        Stem fixation in revision total knee arthroplasty: a comparative analysis.
        Clin Orthopaedics Relat Res. 2003; 416: 217-224
        • Zanirato A.
        • Formica M.
        • Cavagnaro L.
        • Divano S.
        • Burastero G.
        • Felli L.
        Metaphyseal cones and sleeves in revision total knee arthroplasty: two sides of the same coin? Complications, clinical and radiological results-a systematic review of the literature.
        Musculoskelet Surg. 2020; 104: 25-35
        • Alipit V.
        • Kirk A.
        • Scholl D.
        • Schmidig G.
        • Springer B.D.
        • Lee G.C.
        Micromotion analysis of various tibial constructs in moderate tibial defects in revision total knee arthroplasty.
        J Arthroplasty. 2021; 36: 362-367
        • Edwards P.K.
        • Fehring T.K.
        • Hamilton W.G.
        • Perricelli B.
        • Beaver W.B.
        • Odum S.M.
        Are cementless stems more durable than cemented stems in two-stage revisions of infected total knee arthroplasties?.
        Clin Orthopaedics Relat Res. 2014; 472: 206-211
        • Divano S.
        • Cavagnaro L.
        • Zanirato A.
        • Basso M.
        • Felli L.
        • Formica M.
        Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature.
        Arch Orthopaedic Trauma Surg. 2018; 138: 851-863