Mid term outcomes of a novel metaphyseal porous titanium cone in revision total knee arthroplasty

Authors

Ittai Shichman, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
Utkarsh Anil, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
Gijs van Hellemondt, Department of Orthopedic Surgery, Sint Maartensklinek, Ubbergen, Gelderland, Netherlands.
Shashank Gupta, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
Jore Willems, Department of Orthopedic Surgery, Sint Maartensklinek, Ubbergen, Gelderland, Netherlands.
Ajit J. Deshmukh, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
Jose A. Rodriguez, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
William B. Lutes, Advocate Aurora Health
Ran Schwarzkopf, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.

Recommended Citation

Shichman I, Anil U, van Hellemondt G, et al. Mid term outcomes of a novel metaphyseal porous titanium cone in revision total knee arthroplasty. J Clin Orthop Trauma. 2023;46:102282. Published 2023 Nov 14. doi:10.1016/j.jcot.2023.102282

Affiliations

Aurora Medical Center, Kenosha

Abstract

Introduction:Bone loss is present in all revision total knee arthroplasties. Metaphyseal cones allow surgeons to negotiate loss of femoral and tibial bone stock while obtaining stable bony fixation. This study examines the mid-term functional and radiographic outcomes in patients undergoing revision total knee arthroplasty (rTKA) utilizing a novel metaphyseal cone system.

Methods:This multicenter retrospective study examined all patients who received a porous, titanium tibial or femoral cone at four academic urban tertiary care institutions and presented for a minimum two-year follow-up. Patient demographics, indications for revision surgery, knee range-of-motion (ROM), re-revision rates, radiographic measurements, bone defect per AORI classification, and implant osseointegration were evaluated according to the Knee Society total knee arthroplasty (TKA) radiographic evaluation system.

Results:One-hundred and four patients received 128 cone implants (84 tibial, 44 femoral cones; 24 patients with simultaneous ipsilateral tibial and femoral cones; 104 rTKA) with mean follow-up of 32.75 ± 6.54 months. The pre-operative main revision indications were aseptic loosening 36 (34.61 %), periprosthetic infection (PJI) 23 (22.11 %) and instability 18 (17.3 %). Thirteen rTKA underwent re-revision surgery: 3 for acute PJI, 4 for chronic PJI, 5 for instability, and 1 for mechanical failure of a hinged system. At most recent radiographic follow-up available, all unrevised cones had evidence of osteointegration and no visible implant migration.All-cause re-operation free survivorship was 87.5 % (91/104), and all-cause cone implant survivorship was 96.09 % (123/128 cones) at 2-year follow-up.

Conclusion:This study demonstrates excellent mid-term outcomes of a novel porous, titanium metaphyseal cone in patients with large bone defects undergoing complex revision TKA.

Document Type

Article

PubMed ID

38196965