Bone mineral density changes of the proximal tibia after revision total knee arthroplasty. A randomised study with the use of porous tantalum metaphyseal cones

Jensen, Charlotte; Petersen, Michael Mørk; Schrøder, Henrik Morville; Lund, B.

doi:10.1007/s00264-012-1601-y

Cited by 30 publications

(32 citation statements)

References 26 publications

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“…Regarding rTKAs, our data suggest that in the distal femur and proximal tibia a bone resorption is consistent, while no substantial modification is revealed at the tip of femoral stems (ROI 4). This is significantly different from what reported in a previous study, in which an increase in the femur at the tip of stems has been found (34). By using a high press-fit stem for the tibial component in rTKA we have observed a bone apposition at 3 and 6 months, and a lesser resorption at 24 months compared to the low press-fit implantation (53).…”

Section: Discussioncontrasting

confidence: 56%

“…By using a high press-fit stem for the tibial component in rTKA we have observed a bone apposition at 3 and 6 months, and a lesser resorption at 24 months compared to the low press-fit implantation (53). Bone remodelling activity in THA and in rTKA is a process that seems to intensively develop during the first year after surgery, then reducing in the second year (32,34,47,(54)(55)(56)(57). Such observations, associated to other reported in literature have aroused a great interest in the proposal of bone metabolic therapies to improve the quality of osseointegration, particularly in the first months after an arthroplasty (12,57,(58)(59)(60).…”

Section: Discussionmentioning

confidence: 99%

“…For the evaluation of THAs, the periprosthetic bone was studied by the analysis of the 7 Region of Interests (ROI) around the stem according to Gruen (31) (Figures 3, 4). In case of rTKAs 8 ROI were evaluated (32)(33)(34) (Figures 5, 6). …”

Section: Methodsmentioning

confidence: 99%

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Densitometric evaluation of bone-prosthetic counterface in hip and knee arthroplasty with modern implants

Lepri

Giorgini

Signorini

et al. 2016

ccmbm

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SummaryIntroduction. Recent acquisitions of the complex mechanisms of osseointegration between implants and host bone have gained attention, accordingly to the methods of evaluation of these interactions. DEXA analysis is considered an useful tool to assess such phenomena, in order to analyse in a quantitative manner the local metabolic activity of the bone, and to evaluate over the time the integration between host bone and prosthetic components. The purpose of the present study is to report about a preliminary experience in the analysis of osseointegration processes of patients undergoing a primary Total Hip Arthroplasty (THA) or a revision Total Knee Arthroplasty (rTKA). Materials and methods. Thirty patients undergoing THA and nineteen undergoing rTKA were included in this study. In fifteen cases of THA a standard cementless stem was used; in the other fifteen a short cementless stem was chosen. In all cases a cementless cup was implanted. In all patients undergoing rTKA, all implants had pressfit femoral and tibial diaphyseal stems; only the femoral component and the tibial plateau were cemented. DEXA evaluation was performed preoperatively, and at 3, 6, 12, and 24

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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Densitometric evaluation of bone-prosthetic counterface in hip and knee arthroplasty with modern implants

Lepri

Giorgini

Signorini

et al. 2016

ccmbm

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“…9 There may be a lower rate of infection with these cones compared with bulk allografts, but this has not been conclusively proven. As opposed to allograft bone, the metaphyseal cones will not have a possibility of late bone resorption and possible fracture.…”

Section: Methodsmentioning

confidence: 96%

Porous metal metaphyseal cones for severe bone loss

Lachiewicz

Watters

2014

The Bone & Joint Journal

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Metaphyseal bone loss is common with revision total knee replacement (RTKR). Using the Anderson Orthopaedic Research Institute (AORI) classification, type 2-B and type 3 defects usually require large metal blocks, bulk structural allograft or highly porous metal cones. Tibial and femoral trabecular metal metaphyseal cones are a unique solution for large bone defects. These cones substitute for bone loss, improve metaphyseal fixation, help correct malalignment, restore the joint line and may permit use of a shorter stem. The technique for insertion involves sculpturing of the remaining bone with a high speed burr and rasp, followed by press-fit of the cone into the metaphysis. The fixation and osteoconductive properties of the porous cone outer surface allow ingrowth and encourage long-term biological fixation. The revision knee component is then cemented into the porous cone inner surface, which provides superior fixation compared with cementing into native but deficient metaphyseal bone. The advantages of the cone compared with allograft include: technical ease, biological fixation, no resorption, and possibly a lower risk of infection. The disadvantages include: difficult extraction and relatively short-term follow-up. Several studies using cones report promising short-term results for the reconstruction of large bone defects in RTKR.

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“…Because of the porosity of this material, osseointegration and penetration of the cement is improved [3]. Metaphyseal filling provides more balanced transfer of peripheral loads, reducing the risk of repeat loosening [4]. Meneghini et al [5] described the use of a porous tantalum cone for tibial bone defects during revision TKA.…”

Section: Introductionmentioning

confidence: 98%

Tantalum cones and bone defects in revision total knee arthroplasty

Boureau

Putman

Arnould

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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Management of bone loss is a major challenge in revision total knee arthroplasty (TKA). The development of preformed porous tantalum cones offers new possibilities, because they seem to have biological and mechanical qualities that facilitate osseointegration. Compared to the original procedure, when metaphyseal bone defects are too severe, a single tantalum cone may not be enough and we have developed a technique that could extend the indications for this cone in these cases. We used 2 cones to fill femoral bone defects in 7 patients. There were no complications due to wear of the tantalum cones. Radiological follow-up did show any migration or loosening. The short-term results confirm the interest of porous tantalum cones and suggest that they can be an alternative to allografts or megaprostheses in case of massive bone defects.

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Bone mineral density changes of the proximal tibia after revision total knee arthroplasty. A randomised study with the use of porous tantalum metaphyseal cones

Cited by 30 publications

References 26 publications

Densitometric evaluation of bone-prosthetic counterface in hip and knee arthroplasty with modern implants

Densitometric evaluation of bone-prosthetic counterface in hip and knee arthroplasty with modern implants

Porous metal metaphyseal cones for severe bone loss

Tantalum cones and bone defects in revision total knee arthroplasty

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