No Difference Between Trabecular Metal Cones and Femoral Head Allografts in Revision TKA: Minimum 5-year Followup

Abstract

Background Encouraging clinical results have been reported with the use of femoral head structural allografts and, more recently, trabecular metal cones for the management of large structural defects of the femur and tibia during revision total knee arthroplasty (TKA). However, to our knowledge, there are no published studies comparing these two techniques. Questions/purposes Compared with bulk allografts, do trabecular metal cones result in (1) better validated outcomes scores; (2) a lower risk of loosening or revision at 5 years; and (3) fewer surgical complications when used for the management of bone loss in revision TKA?Methods Between 2002 and 2008, three surgeons performed 450 TKA revisions, 45 (10%) of which were performed using augmentation of host bone; in those, femoral head allograft was used in 30 (75%) and trabecular metal cones in 15 (25%). From 2002 to 2007, femoral head allografts were used in all patients (28 patients); from 2007 to 2008, trabecular metal augments were used in all patients. There was a period of 1 year (16 knees) in which there was some overlap; during that time, femoral head structural allografts were used in cases in which we were unable to fit the defect or achieve adequate stability with trabecular metal cones. Followup was at a mean of 9 years (range, 5-12 years). No patients were lost to followup. Knee function and quality of life were assessed using the Oxford Knee Score, WOMAC, SF-12, and the UCLA activity score. Radiographs were assessed for signs of loosening. Surgical complications included superficial or deep infections, iatrogenic fractures, symptomatic deep venous thromboses or pulmonary emboli, and blood loss requiring transfusion; these were obtained from our database and from review of patients' charts. Results The mean Oxford Knee Score in the allograft and trabecular metal cone groups was 91 (SD 10) and 91 (SD 14), respectively (95% confidence interval [CI], 88-94; p = 0.29). Mean WOMAC scores were 94 (SD 10) and 92 (SD 14), respectively (95% CI, 80-105; p = 0.52) and mean UCLA scores were 6 (SD 1.2) and 6 (SD 1.5), respectively (95% CI, 4-8; p = 0.49). Five-and 10-year survivorship of the allografts was 93% (95% CI, 77-98) and 93% (95% CI, 77-99), respectively. Survivorship at a mean of 5 years in the trabecular metal cones group was 91% (95% CI, 56-98). With the numbers available, there were no differences between the groups in terms of the frequency of surgical complications (3% [one of 30] versus 7% [one of 15]; odds ratio, 0.5; p = 0.632).

The role of rotating hinge implants in revision total knee arthroplasty

“…Likewise, the risk of poor implant fixation in the metaphyseal bone forces us to secure the metaphyseal bridging by a diaphyseal stem associated with a hinged implant. 56 Re-operations of revision cases with constrained or hinged implants are carried out using hinged implants to address instability and bone defects problems (Fig. 6).…”

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

“…Osseous defects of cases coming to rTKR are commonly categorized in accordance with the Anderson Orthopaedic Research Institute (AORI) Classification . AORI IIB defects, which consist of cancellous and cortical metaphyseal bone loss in both tibial/femoral condyles, are most common and are encountered in up to 42% of rTKR's …”

Impaction Bone Grafting in Revision Total Knee Arthroplasty—Using Mesh and Cone to Contain the Defect: A Report of 3 Cases

“…Contrarily, in a study by Sandiford et al, no differences in the revision rate, outcome scores, and radiographic loosening between the use of metal cones and femoral head allograft were found [ 10 ].…”

“…Trabecular metal cones (Zimmer Biomet, Warsaw, IN) are also associated with a good outcome and show a survivorship of 91% at a mean of 5-year follow-up [ 9 , 10 ].…”