Metaphyseal cones and sleeves in revision total knee arthroplasty: Two sides of the same coin? Complications, clinical and radiological results—a systematic review of the literature

Zanirato, Andrea; Formica, Matteo; Cavagnaro, Luca; Divano, Stefano; Burastero, Giorgio; Felli, Lamberto

doi:10.1007/s12306-019-00598-y

Cited by 55 publications

(60 citation statements)

References 47 publications

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“…Поэтому у ряда пациентов установить удлиняющую ножку становится невозможным, и если это сочетается с дефицитом костной массы эпифиза, то компрометируется принцип достижения фиксации ревизионного имплантата как минимум в двух зонах [11]. Вместе с тем результаты использования металлических втулок с напылением (средний срок наблюдения 3,6±1,4 лет) и конусов (средний срок наблюдения 4,5±1,6 лет) показывают хорошую выживаемость имплантатов в раннем и среднесрочном периодах (97,3 и 97,8% соответственно) [12].…”

Section: Discussionunclassified

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Cherny

Коваленко

Билык

et al. 2019

Traumatology and Orthopedics of Russia

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The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

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Section: Discussionunclassified

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Cherny

Коваленко

Билык

et al. 2019

Traumatology and Orthopedics of Russia

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“…Nevertheless, high fracture rates have been reported for first-generation tantal cones, and there is a risk of avulsion of the patella tendon. In addition, bone preparation is sometimes challenging [12,14,[28][29][30]]. An intraoperative fracture in the case of a Charcot knee can result in catastrophic consequences.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Tsamassiotis

Ettinger

2021

Case Reports in Surgery

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Charcot arthropathy of the knee is an extremely rare orthopedic disease that is very challenging for the treating physician and is associated with many complications, especially if it is occurring on both knees. Meanwhile, in the advanced stage, despite many potential complications, TKA is recognized as the gold standard. However, destruction of the medial tibial plateau is typical for the disease, which makes a stable anchorage of the prosthesis much more difficult. Therefore, we present a case in which sufficient primary stability could be achieved with an asymmetrical second-generation tibial cone with an anatomical design and implantation instruments adapted to the bony anatomy in the presence of severe tibial destruction on both sides. In the two-year follow-up, the patient showed good mobility and stability on both sides. In advanced Charcot arthropathy of the knee, the use of asymmetric tibial cones appears to be an appropriate solution for secure fixation and stability of the implant.

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“…In a systematic review from 2018, Divano et al observed an intraoperative fracture cones-related rate of 0.89% [ 13 ]. A recent systematic review from 2020 evaluated 927 cones and reported an intraoperative fracture rate of 1.2 ± 4.8% [ 24 ]. This suggests that those types of implants are safe to use in principle.…”

Section: Discussionmentioning

confidence: 99%

Individual Revision Knee Arthroplasty Is a Safe Limb Salvage Procedure

Savov

Tuecking

Ettinger

2021

JPM

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Introduction: Revision total knee arthroplasty after multiple pre-surgeries is challenging. Due to severe bone defects, standard implants for metaphyseal and diaphyseal anchoring may no longer be suitable. The primary aim of this case series is to evaluate the early complication rate for individual knee implants with custom-made cones and stems after two-stage revision with severe bone defects. Methods: Ten patients who were treated with custom-made 3D-printed knee revision implants were included. Inclusion criteria were a two-stage revision due to late-onset or chronic periprosthetic joint infection as well as aseptic loosening. All severe bone defects were AORI type III. All procedure-related complications were evaluated. Postoperative range of motion after one year was measured. The time between the two surgeries was evaluated. Results: The mean follow-up was 21 months (range: 12–40). The mean time between the two-stage surgeries was 71.6 days. No fractures were observed intra- and postoperatively. Two patients were revised without changing metal components due to persistent hematoma (three weeks post-surgery) and persistent PJI (three months post-surgery). The mean passive postoperative range of motion was 92° (range: 80–110°). Conclusions: Individual custom-made implants for rTKA provide a safe procedure for patients with huge bone defects after several pre-surgeries. If standard knee systems with standard cones or sleeves are not suitable anymore, custom-made treatment offers the patient the last option for limb preservation. However, this is associated with increased costs.

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Metaphyseal cones and sleeves in revision total knee arthroplasty: Two sides of the same coin? Complications, clinical and radiological results—a systematic review of the literature

Cited by 55 publications

References 47 publications

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Individual Revision Knee Arthroplasty Is a Safe Limb Salvage Procedure

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