Stacked Titanium Metaphyseal Cones for Reconstruction of Large Tibial Defects in Revision Knee Arthroplasty

Abstract

Failed total knee arthroplasties with large bone defects are increasing rapidly because of the growing population of young, active patients undergoing primary total knee arthroplasty. There are limited options when tibial metaphyseal bone loss is so extensive that a tibial component with augments and thickest available polyethylene cannot fill flexion and extension gaps once the femoral component is appropriately positioned. Previously, allograft or megaprostheses would be required. However, allografts require contouring and fixation and may not incorporate into surrounding bone. Most endoprostheses do not osseointegrate and are associated with high risk of failure. To our knowledge, we are the first to describe stacked porous titanium cones for reconstruction of massive tibial metaphyseal defects, a straightforward technique with standard revision implants highly likely to osseointegrate.

Correction of Severe Posterior Tibial Slope in Revision Total Knee Arthroplasty With Cementation and Cone Technology

“…Smaller, contained defects have been successfully managed by cementation techniques and are often reinforced with screws for added biomechanical restoration. Many earlier studies have advocated for the use of cement and screws to address tibial defects confined to 5 mm or less [ 1 , 2 , 13 ]. A large series by Berend et al with a mean follow-up of 7.4 years showed no difference in failure rates between screw and cement fixation compared to no screws in patients undergoing revision of either femoral or tibial components for failed TKA when the osseous defect was >5 mm in size and >50% of plateau or condylar deformity [ 14 ].…”

Utilization of a Revision Acetabular Shell as a Tibial Cone in a Revision Total Knee Arthroplasty Setting

“…There are multiple case reports and case series that describe a stacked cone technique, in which multiple metaphyseal cones are stacked for increased fixation in the setting of a severe metaphyseal defect. This is a useful technique when the largest metaphyseal cones are only able to achieve fixation below the joint line, and increased length of the construct is needed [ 7 , 8 , 9 ]. Another case series by Stambough et al.…”