Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Abstract

Background Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions. Questions/purposes We wished to determine the midterm (1) reoperation rates for septic and aseptic causes, (2) radiologic findings of osseointegration, and (3) clinical outcomes based on the Knee Society score in patients who underwent revision knee arthroplasty with tantalum cones for severe bone loss. Methods We retrospectively evaluated records of 18 patients (18 knees) who underwent revision knee arthroplasty with use of tantalum cones between 2005 and 2008; the primary indications for use of this approach were to reconstruct massive bone defects classified as Anderson Orthopaedic Research Institute Types 2B and 3. During this period, all defects of this type were treated with this approach and no cones were used for more-minor defects. A total of 26 cones (13 tibial and 13 femoral) were implanted. There were 12 female and six male patients with a mean age of 73 years (range, 55-84 years) at the time of revision. The indication for the revision included aseptic loosening (five patients) and second-stage reimplantation for deep infection (13 patients). Patients were followed for a mean of 6 years (range, 5-8 years). No patient was lost to followup. Clinical and radiographic outcomes were assessed with the Knee Society clinical rating system and radiographic evaluation system.

Treatment of Bone Losses in Revision Total Hip and Knee Arthroplasty Using Trabecular Metal: Current Literature

“…In 2015 three papers with considerable population and midterm follow-up were published. De Martino et al [68] described their results with 26 (both femoral and tibial) cones at 72 months of follow-up. No evidence of loosening of the cones was detected, and the authors stated that tantalum cones for reconstruction of massive bone defects provided secure fixation and outcomes at average follow-up of 6 years.…”

Total knee surgery: Our experience licensing

“…(19), Meneghini et al (18) and Long and Scuderi (17) having an unquestionable osteointegration of the cones and similar percent for the need of reoperation. The increase of the Knee Society score in terms of pre and postoperative numbers is similar to other studies (2,16,20).…”

“…The femoral cone augment is designed to contribute the reconstruction in rotation, and the asymmetric design follows the anatomic direction of the femoral bone during centralization. Eventual gaps between the porous surface and the host bone should be filled with morselized bone allograft, autograft or bone substitutes (3). Histological studies have shown low potential for bacterial adherence with greater leucocyte activation, reducing the risk of infections (4,5).…”

Comparative Analysis between Cone and Sleeve in Managing Severe Bone Defect during Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

“…Among these, there was 1 RCT (level I), 13 1 cohort study (level III), 5 and 17 case series (level IV). 6,8,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Thirteen studies (total 448 patients and 449 knees) 6,8,13,17,18,[20][21][22][23][24][25]27,28 and 6 studies (total 318 patients and 326 knees) 5, [14][15][16]19,26 used cone and sleeve, respectively, as an augment. Each augment was used in the tibial and femoral bone defect with all degrees of severity and with all kinds of constraint (►Table 1).…”

“…Fourteen studies 5,6,[14][15][16][17]19,21,[23][24][25][26][27][28] used augment for both femur and tibia, four studies 8,13,20,29 used augment only in the tibia, and one study 18 only in the femur. Fourteen (74%) studies used augment only in AORI II and III defect and four studies included AORI type I in the evaluation.…”