Porous Tantalum Metaphyseal Cones for Severe Tibial Bone Loss in Revision Knee Arthroplasty

Kamath, Atul F.; Lewallen, David G.; Hanssen, Arlen D.

doi:10.2106/jbjs.n.00540

Cited by 165 publications

(142 citation statements)

References 39 publications

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“…There was radiographic component incorporation in all patients in their studies. As more longterm reports [10] become available, such techniques may prove to be good options for improved fixation in patients with morbid obesity.…”

Section: Discussionmentioning

confidence: 99%

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Watts

Wagner

Houdek

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients with obesity are known to have a higher risk of complications after primary TKA; however, there is a paucity of data regarding the effects of obesity with revision TKAs. Questions/purposes We asked the following questions : (1) Are patients with morbid obesity (BMI C 40 kg/m 2 ) at greater risk for repeat revision, reoperation, or periprosthetic joint infection (PJI) compared with patients without obesity (BMI \ 30 kg/m 2 ) after an index revision TKA performed for aseptic reasons? (2) Do patients who are not obese achieve higher Knee Society pain and function scores after revision TKA for aseptic reasons? Methods We used a retrospective cohort study with 1:1 matching for sex, age (± 3 years) and date of surgery (± 1 year) to compare patients with morbid obesity with patients without obesity with respect to repeat revision, reoperation, and PJI. Using our institution's total joint registry, we identified 1291 index both-component (femoral and tibial) aseptic revision TKAs performed during a 15-year period (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007). Of these, 120 revisions were in patients with morbid obesity (BMI C 40 kg/ m 2 ) and 624 were in patients with a BMI less than 30 kg/ m 2 . We then considered only patients with a minimum 5-year followup, which was available for 77% of patients with morbid obesity and 76% of patients with a BMI less than 30 kg/m 2 (p = 0.84). All patients with morbid obesity who met criteria were included (morbid obesity group: n = 93; average followup, 7.9 years) and compared with a matched cohort of patients with a BMI less than 30 kg/m 2 (nonmorbid obesity group: n = 93; average followup, 7.3 years). Medical records were reviewed to gather details regarding complications and clinical outcomes. Results Overall, patients with morbid obesity had an increased risk of repeat revision (hazard ratio [HR], 3.8; 95% CI, 1.2-16.5; p \ 0.02), reoperation (HR, 2.9; 95% CI, 1.3-7.4; p \ 0.02), and PJI (HR, 6.4; 95% CI, 1.2-119.7; p \ 0.03). Implant survival rates were 96% (95% CI, 92%-100%) and 100% at 5 years, and 81% (95% CI, 70%-92%) and 93% (95% CI, 86%-100%) at 10 years for the patients with morbid obesity and those without morbid obesity, respectively (p = 0.02). At 10 years, The Knee Society pain (90 [95% CI,(88)(89)(90)(91)(92) Conclusion Morbid obesity is associated with increased rates of rerevision, reoperation, and PJI after aseptic revision TKA. As the time-sensitive nature of revision surgery may not always allow for patient or comorbidity optimization, these results emphasize the need for improving our care of patients with morbid obesity earlier on during

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Section: Discussionmentioning

confidence: 99%

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Watts

Wagner

Houdek

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Lachiewicz et al [19] experienced no failures at 39-month followup in their cohort of 27 knees. In larger series, Kamath et al [16] reported [ 95% survivorship at an average 70-month followup, whereas Graichen et al [12] found 89% survivorship in 193 sleeves at a mean 42-month followup. The results of our study are comparable to the best published results with the use of femoral head allografts.…”

Section: Resultsmentioning

confidence: 98%

“…Alexander [6], Huang et al [15], Agarwal et al [1], and Graichen and colleagues [12] reported statistically significant improvements in the KSS, Oxford, and WOMAC scores at an average of 2 to 4 years postsurgery in patients treated using trabecular metal cones. Kamath et al [16] reported a KSS score of 80 points (representing a sustained improvement of 25 points) at a minimum 5-year followup with the use of trabecular metal cones. This report is from a designer surgeon series; however, it does represent one of the longest published series with the use of trabecular metal cones.…”

Section: Resultsmentioning

confidence: 99%

“…A number of options have been used for managing large bone deficiencies in revision TKA including allograft-prosthetic composites [10] with or without hinged prostheses [28] and impaction grafting [29]. Two techniques that have been described in the literature include the use of femoral head allografts [18,25,30] and, more recently, metaphyseal porous metal cones [16,19,20].…”

Section: Introductionmentioning

confidence: 99%

“…Survivorship for metaphyseal cones has been reported to be 85% to 100% [12,16,19] although the results are short term. To our knowledge, there are no published studies at medium term comparing these two techniques using validated patientreported outcome measures.…”

Section: Introductionmentioning

confidence: 99%

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No Difference Between Trabecular Metal Cones and Femoral Head Allografts in Revision TKA: Minimum 5-year Followup

Sandiford

Misur

Garbuz

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Encouraging clinical results have been reported with the use of femoral head structural allografts and, more recently, trabecular metal cones for the management of large structural defects of the femur and tibia during revision total knee arthroplasty (TKA). However, to our knowledge, there are no published studies comparing these two techniques. Questions/purposes Compared with bulk allografts, do trabecular metal cones result in (1) better validated outcomes scores; (2) a lower risk of loosening or revision at 5 years; and (3) fewer surgical complications when used for the management of bone loss in revision TKA?Methods Between 2002 and 2008, three surgeons performed 450 TKA revisions, 45 (10%) of which were performed using augmentation of host bone; in those, femoral head allograft was used in 30 (75%) and trabecular metal cones in 15 (25%). From 2002 to 2007, femoral head allografts were used in all patients (28 patients); from 2007 to 2008, trabecular metal augments were used in all patients. There was a period of 1 year (16 knees) in which there was some overlap; during that time, femoral head structural allografts were used in cases in which we were unable to fit the defect or achieve adequate stability with trabecular metal cones. Followup was at a mean of 9 years (range, 5-12 years). No patients were lost to followup. Knee function and quality of life were assessed using the Oxford Knee Score, WOMAC, SF-12, and the UCLA activity score. Radiographs were assessed for signs of loosening. Surgical complications included superficial or deep infections, iatrogenic fractures, symptomatic deep venous thromboses or pulmonary emboli, and blood loss requiring transfusion; these were obtained from our database and from review of patients' charts. Results The mean Oxford Knee Score in the allograft and trabecular metal cone groups was 91 (SD 10) and 91 (SD 14), respectively (95% confidence interval [CI], 88-94; p = 0.29). Mean WOMAC scores were 94 (SD 10) and 92 (SD 14), respectively (95% CI, 80-105; p = 0.52) and mean UCLA scores were 6 (SD 1.2) and 6 (SD 1.5), respectively (95% CI, 4-8; p = 0.49). Five-and 10-year survivorship of the allografts was 93% (95% CI, 77-98) and 93% (95% CI, 77-99), respectively. Survivorship at a mean of 5 years in the trabecular metal cones group was 91% (95% CI, 56-98). With the numbers available, there were no differences between the groups in terms of the frequency of surgical complications (3% [one of 30] versus 7% [one of 15]; odds ratio, 0.5; p = 0.632).

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