Metaphyseal Fixation Using Highly Porous Cones in Revision Total Knee Arthroplasty: Minimum Two Year Follow Up Study

Denehy, Kevin; Abhari, Sarag; Krebs, Viktor E.; Higuera-Rueda, Carlos A.; Samuel, Linsen T.; Sultan, Assem A.; Mont, Michael A.; Malkani, Arthur L.

doi:10.1016/j.arth.2019.03.045

Cited by 56 publications

(45 citation statements)

References 25 publications

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“…The instrumentation required for bone preparation is also adapted to the bony anatomy. A streamlined reamer-based instrumentation replaces the manual high-speed drilling of the first generation and provides immediate press fit [ 31 , 32 ]. In addition, the asymmetric variant of the tibial cone used in this case enables a sufficient and primary stable reconstruction of the bone defect of the medial tibial plateau, which is typical for Charcot knees.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Tsamassiotis

Ettinger

2021

Case Reports in Surgery

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Charcot arthropathy of the knee is an extremely rare orthopedic disease that is very challenging for the treating physician and is associated with many complications, especially if it is occurring on both knees. Meanwhile, in the advanced stage, despite many potential complications, TKA is recognized as the gold standard. However, destruction of the medial tibial plateau is typical for the disease, which makes a stable anchorage of the prosthesis much more difficult. Therefore, we present a case in which sufficient primary stability could be achieved with an asymmetrical second-generation tibial cone with an anatomical design and implantation instruments adapted to the bony anatomy in the presence of severe tibial destruction on both sides. In the two-year follow-up, the patient showed good mobility and stability on both sides. In advanced Charcot arthropathy of the knee, the use of asymmetric tibial cones appears to be an appropriate solution for secure fixation and stability of the implant.

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Section: Discussionmentioning

confidence: 99%

“…The asymmetric tibial cone also offers the surgeon up to 10° of rotational freedom and is characterized by good accuracy of fit. Under physiological load, these cones, made of porous titanium, are at least equivalent and in some cases superior to tantal cones in terms of mechanical stability [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Tsamassiotis

Ettinger

2021

Case Reports in Surgery

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“…Given the advancement of 3D printing technology, 3D-printed implants are also available in the market for bone defect reconstruction in RTKA. A study of 62 RTKA cases, in which metaphyseal tibial cones were applied for AORI type II or III tibial defects, followed-up on average of 27 months by Denehy et al [23] shows that the revisionfree survival of the cones was 90.2% (the survivorship was 100% if the infection was excluded) with the notable improvement of patients' postoperative functions. Even though the 3D-printed cones were involved in this study, they were manufactured into several xed sizes (symmetrical and unsymmetrical).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction for massive proximal tibial bone defects using patient-customized three-dimensional-printed metaphyseal cones in revision total knee arthroplasty

Yang¹,

Wang²,

Tian³

2020

Preprint

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Background The reconstruction of massive bone defects is one of the main challenges in revision total knee arthroplasty (RTKA). Although several methods are available, each of them has its prominent shortcomings. The purpose of this study is to review the clinical outcomes of RTKA with massive proximal tibial bone defects using patient-customized three-dimensional (3D)-printed highly porous metaphyseal cones. Methods We retrospectively reviewed seven RTKAs with Anderson Orthopaedic Research Institute (AORI) type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones, which have been performed at a single institution between 2016 and 2018. The mean length of follow-up was 25.3 months (19–36). Results The mean age at diagnosis of the patients was 68 years old (61–77). At the latest follow-up, no aseptic loosening or prosthetic joint infection has been determined. The mean HSS increased from 49 (39–63) to 78 (70–83) (P < 0.01); the mean WOMAC increased from 59 (46–73) to 26 (12–38) (P < 0.01). All patients obtained the range of motion and mechanical alignment improvement postoperatively. Conclusion The patient-customized 3D-printed metaphyseal cone could be a promising technique in addressing severe tibial defects in RTKA. Our study shows encouraging short-term clinical and radiological outcomes with no aseptic loosening, periprosthetic infection, or fracture. Nevertheless, further follow-up and the expansion of sample size are needed to demonstrate the advantage of this innovative technique fully.

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“…Given the advancement of 3D printing technology, 3D-printed implants are also available in the market for bone defect reconstruction in RTKA. A study of 62 RTKA cases, in which metaphyseal tibial cones were applied for AORI type II or III tibial defects, followed-up on average of 27 months by Denehy et al [23] shows that the revision-free survival of the cones was 90.2% (the survivorship was 100% if the infection was excluded) with the notable improvement of patients' postoperative functions. Even though the 3D-printed cones were involved in this study, they were manufactured into several xed sizes (symmetrical and unsymmetrical).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-customized Three-dimensional-printed Metaphyseal Cones in Revision Total Knee Arthroplasty

Wang

Tian

2020

Preprint

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Background: The reconstruction of massive bone defects is one of the main challenges in revision total knee arthroplasty (RTKA). Although several methods are available, each of them has its prominent shortcomings. The purpose of this study is to review the clinical outcomes of RTKA with massive proximal tibial bone defects using patient-customized three-dimensional (3D)-printed highly porous metaphyseal cones.Methods: We retrospectively reviewed seven RTKAs with Anderson Orthopaedic Research Institute (AORI) type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones, which have been performed at a single institution between 2016 and 2018. Results: The mean age at diagnosis of the patients was 68 years old (61-77). The mean length of follow-up was 25.3 months (19-36). At the latest follow-up, no aseptic loosening or prosthetic joint infection has been determined. The mean HSS increased from 49 (39-63) to 78 (70-83) (P<0.01); the mean WOMAC increased from 59 (46-73) to 26 (12-38) (P<0.01). All patients obtained the range of motion and mechanical alignment improvement postoperatively.Conclusion: The patient-customized 3D-printed metaphyseal cone could be a promising technique in addressing severe tibial defects in RTKA. Our study shows encouraging short-term clinical and radiological outcomes with no aseptic loosening, periprosthetic infection, or fracture. Nevertheless, further follow-up and the expansion of sample size are needed to demonstrate the advantage of this innovative technique fully.

show abstract

Metaphyseal Fixation Using Highly Porous Cones in Revision Total Knee Arthroplasty: Minimum Two Year Follow Up Study

Cited by 56 publications

References 25 publications

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Reconstruction for massive proximal tibial bone defects using patient-customized three-dimensional-printed metaphyseal cones in revision total knee arthroplasty

Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-customized Three-dimensional-printed Metaphyseal Cones in Revision Total Knee Arthroplasty

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