Ittai Shichman1,2, Christian Oakley1, Jore H Willems3, Gijs G van Hellemondt3, Petra Heesterbeek4, Joshua Rozell1, Scott Marwin1, Ran Schwarzkopf5. 1. Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA. 2. Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. 3. Department of Orthopedic Surgery, Sint Maartensklinek, Ubbergen, Gelderland, The Netherlands. 4. Research Department, Sint Maartensklinek, Ubbergen, Gelderland, The Netherlands. 5. Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA. Ran.Schwarzkopf@nyulangone.org.
Abstract
INTRODUCTION: Loosening and migration are common modes of aseptic failure following complex revision total knee arthroplasty (rTKA). Metaphyseal cones allow surgeons to negotiate the 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 rTKA utilizing a novel metaphyseal cone system with stems of variable length and fixation methods. METHODS: This two-center retrospective study examined all patients who underwent rTKA with a novel porous, titanium tibial or femoral cone in combination with a stem of variable length and fixation who had a minimum follow-up of 2-years. Outcome analysis was separated into tibial and femoral cones as well as the stem fixation method (hybrid vs. fully cemented). RESULTS: Overall, 123 patients who received 156 cone implants were included (74 [60.2%] tibial only, 16 [13.0%] femoral only, and 33 [26.8%] simultaneous tibial and femoral) with a mean follow-up of 2.76 ± 0.66 years. At 2-years of follow-up the total cohort demonstrated 94.3% freedom from all-cause re-revisions, 97.6% freedom from aseptic re-revisions, and 99.4% of radiographic cone osteointegration. All-cause revision rates did not differ between stem fixation techniques in both the tibial and femoral cone groups. CONCLUSION: The use of a novel porous titanium femoral and tibial metaphyseal cones combined with stems in patients with moderate to severe bone defects undergoing complex revision total knee arthroplasty confers excellent results independent of stem fixation technique. LEVEL OF EVIDENCE: IV, case series.
INTRODUCTION: Loosening and migration are common modes of aseptic failure following complex revision total knee arthroplasty (rTKA). Metaphyseal cones allow surgeons to negotiate the 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 rTKA utilizing a novel metaphyseal cone system with stems of variable length and fixation methods. METHODS: This two-center retrospective study examined all patients who underwent rTKA with a novel porous, titanium tibial or femoral cone in combination with a stem of variable length and fixation who had a minimum follow-up of 2-years. Outcome analysis was separated into tibial and femoral cones as well as the stem fixation method (hybrid vs. fully cemented). RESULTS: Overall, 123 patients who received 156 cone implants were included (74 [60.2%] tibial only, 16 [13.0%] femoral only, and 33 [26.8%] simultaneous tibial and femoral) with a mean follow-up of 2.76 ± 0.66 years. At 2-years of follow-up the total cohort demonstrated 94.3% freedom from all-cause re-revisions, 97.6% freedom from aseptic re-revisions, and 99.4% of radiographic cone osteointegration. All-cause revision rates did not differ between stem fixation techniques in both the tibial and femoral cone groups. CONCLUSION: The use of a novel porous titanium femoral and tibial metaphyseal cones combined with stems in patients with moderate to severe bone defects undergoing complex revision total knee arthroplasty confers excellent results independent of stem fixation technique. LEVEL OF EVIDENCE: IV, case series.
Authors: Kevin M Denehy; Sarag Abhari; Viktor E Krebs; Carlos A Higuera-Rueda; Linsen T Samuel; Assem A Sultan; Michael A Mont; Arthur L Malkani Journal: J Arthroplasty Date: 2019-03-28 Impact factor: 4.757
Authors: Omar A Behery; Elaine Z Shing; Ziqing Yu; Bryan D Springer; Thomas K Fehring; Jesse E Otero Journal: J Arthroplasty Date: 2021-11-03 Impact factor: 4.757