Short-term Outcomes of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty

Abstract

Recently, 3-dimensional (3D) printing technology has been used in the development of titanium metaphyseal cones to manage severe bone loss in revision total knee arthroplasty (rTKA). This study assessed (1) radiographs; (2) functional outcomes; (3) complications; and (4) 2-year implant survivorship in patients receiving 3D-printed titanium metaphyseal cones for moderate-to-severe tibial and femoral bone loss in rTKA. A single institution, retrospective chart review was performed for patients with large bone defects treated with a 3D-printed femoral or tibial titanium metaphyseal cone between 2015 and 2017 during rTKA (N=54). Paired sample t tests analyzed Knee Society Scores (KSS). Kaplan–Meier analyses determined implant survivorship when the endpoint was cone revision for aseptic loosening, cone revision for any reason, and reoperation for any reason. The authors found that 51 (98.1%) of 52 available radiographs demonstrated well-fixed components without any evidence of loosening or migration. Mean postoperative KSS scores were significantly higher when compared with preoperative scores (80.4 vs 52.0; P >.001). One patient experienced aseptic loosening of their cone. Seven additional cones were explanted as a consequence of reinfection, 1 of which was removed prior to arthrodesis. Cone survivorship was 98.5% when the endpoint was cone revision due to aseptic loosening, 88.2% when cone revision was due to any reason, and 77.9% for any reoperation. Metaphyseal cones appear to be well-suited for large bone defects during rTKA and the authors' findings suggest that cones may be a viable option for metaphyseal fixation during rTKA. Future studies should focus on their durability during a longer time period. [ Orthopedics . 2021;44(1):43–47.]

Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review

“…Three articles investigated the clinical outcomes of RTKA. Remily et al [ 15 ] and Tetreault et al [ 18 ] reported an improved Knee Society Scores (KSS) during the perioperative period, while Kong et al [ 16 ] indicated that the KSS scores of patients in the static group were not significantly different from the KSS score of patients in the articular group during admission. Both Remily et al and Tetreault et al reported good survivorship.…”

“…Seven of ten articles reported perioperative complications [ 15 , 18 , 19 , 21 – 24 ]. For RTKA surgery, perioperative complications mainly concerned aseptic loosening [ 15 ], periprosthetic fracture [ 18 ], and periprosthetic joint infection [ 18 ].…”

“…Seven of ten articles reported perioperative complications [ 15 , 18 , 19 , 21 – 24 ]. For RTKA surgery, perioperative complications mainly concerned aseptic loosening [ 15 ], periprosthetic fracture [ 18 ], and periprosthetic joint infection [ 18 ]. In RTHA surgery, complications focus on periprosthetic fracture [ 19 , 21 ], recurrent dislocations [ 22 – 24 ], periprosthetic joint infection [ 23 ], and aseptic loosening [ 24 ].…”

“…KSS is a systematic score system that comprises daily living ability, knee range of motion, and other indicators. Three articles [ 15 , 16 , 18 ] both indicated an improved KSS during the perioperative period.…”

Bone loss in aseptic revision total knee arthroplasty: management and outcomes

“…Remily et al. performed a retrospective analysis of 54 patients who underwent an rTKA from 2015 to 2017 for an AORI type II or III defect and were treated with a 3D-printed femoral or tibial porous titanium metaphyseal cone [ 52 ]. Patients had a minimum 2-year follow-up with a mean follow-up of 29.9 months (range 24–42 months).…”