Trabecular Metal Cones Combined With Short Cemented Stem Allow Favorable Outcomes in Aseptic Revision Total Knee Arthroplasty

Jacquet, Christophe; Ros, Fabien; Guy, Sylvain; Parratte, Sébastien; Ollivier, Matthieu; Argenson, Jean-Noël

doi:10.1016/j.arth.2020.08.058

Cited by 40 publications

(41 citation statements)

References 39 publications

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“…The length of the stems might be reduced when these cones or sleeves are used. 22 A recent study, which investigated the use of cones with and without stems, reported slightly lower micromotion amounts when using stems in combination with a cone, but the levels of stress in the bone surrounding the stem, and at the end of the stem, were higher. 23 These techniques were not available at the start of this study.…”

Section: Discussionmentioning

confidence: 96%

No difference in long-term micromotion between fully cemented and hybrid fixation in revision total knee arthroplasty: a randomized controlled trial

Mills

Wymenga

Hellemondt

et al. 2022

The Bone & Joint Journal

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Aims Both the femoral and tibial component are usually cemented at revision total knee arthroplasty (rTKA), while stems can be added with either cemented or press-fit (hybrid) fixation. The aim of this study was to compare the long-term stability of rTKA with cemented and press-fitted stems, using radiostereometric analysis (RSA). Methods This is a follow-up of a randomized controlled trial, initially involving 32 patients, of whom 19 (nine cemented, ten hybrid) were available for follow-up ten years postoperatively, when further RSA measurements were made. Micromotion of the femoral and tibial components was assessed using model-based RSA software (RSAcore). The clinical outcome was evaluated using the Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analogue scale (pain and satisfaction). Results The median total femoral translation and rotation at ten years were 0.39 mm (interquartile range (IQR) 0.20 to 0.54) and 0.59° (IQR 0.46° to 0.73°) for the cemented group and 0.70 mm (IQR 0.15 to 0.77) and 0.78° (IQR 0.47° to 1.43°) for the hybrid group. For the tibial components this was 0.38 mm (IQR 0.33 to 0.85) and 0.98° (IQR 0.38° to 1.34°) for the cemented group and 0.42 mm (IQR 0.30 to 0.52) and 0.72° (IQR 0.62° to 0.82°) for the hybrid group. None of these values were significantly different between the two groups and there were no significant differences between the clinical scores in the two groups at this time. There was only one re-revision, in the hybrid group, for infection and not for aseptic loosening. Conclusion These results show good long-term fixation with no difference in micromotion and clinical outcome between fully cemented and hybrid fixation in rTKA, which builds on earlier short- to mid-term results. The patients all had type I or II osseous defects, which may in part explain the good results. Cite this article: Bone Joint J 2022;104-B(7):875–883.

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Section: Discussionmentioning

confidence: 96%

No difference in long-term micromotion between fully cemented and hybrid fixation in revision total knee arthroplasty: a randomized controlled trial

Mills

Wymenga

Hellemondt

et al. 2022

The Bone & Joint Journal

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“…If the bone defect is primarily manifested as substantial cavitary loss of cancellous bone at the metaphysis and the surrounding cortical bone is relatively intact, then augmentation, either in block or wedge, is not recommended for defect reconstruction ( 60 ). Instead, metaphyseal sleeves and cones are ideal alternatives to ensure a preferable clinical outcome ( 61 , 62 ). Generally, the geometry and appearance of sleeves and cones are analogical, but they have different design concepts and surgical techniques ( Fig.…”

Section: Design and Rationale Of Prostheses In Rtkamentioning

confidence: 99%

“…Both sleeves and cones are designed to repair metaphyseal cavitary defects by biological fixation, and they are beneficial for eliminating the concerns associated with traditional autogenous bone grafting, such as graft resorption, disease transmission, improper graft size, and allograft fracture ( 61 , 62 ). However, the cone tends to work as augmentation and plays a minimal role in the initial stabilization of the core implant, while the sleeve has the dual characteristics of fixation and augmentation.…”

Section: Design and Rationale Of Prostheses In Rtkamentioning

confidence: 99%

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

Zhang

2022

EFORT Open Reviews

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The number of primary and revision total knee arthroplasties (rTKAs) continues to increase annually. To date, most of the literature has focused on the surgical technique and outcome of revision prostheses. Thanks to the contributions of surgeons, engineers, and researchers, the design of prostheses has reached a prominent milestone. However, very limited discussion regarding the design, rationale and constitution of prostheses has been documented at present. An electronic search of four online databases (Embase, MEDLINE, PubMed, and Google Scholar) was conducted to identify eligible resources. Forty-four review articles were acquired by searching the terms ‘prosthesis selection’, ‘prosthesis option’, and ‘prosthesis determination’ in rTKA. Sixty-eight research articles investigating the factors affecting prosthesis options in rTKA were screened and integrated with the authors’ perspective to reach a final recommendation. This article first discusses the pathological, individual, and other factors affecting prosthesis options in rTKA and further illustrates the classification, geometry, biomechanics, and constitution of the revision system from the authors’ perspective. An evidence-based recommendation in the form of a matching algorithm was formulated. This review offers special value for decision-making regarding prosthesis options in rTKA. Particularly, it presents specific recommendations regarding unclear practical issues, such as the optimal level of constraint, individualized design, length, and fixation of extension stem, as well as the pros and cons of modularity.

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“…6 Por el contrario, los conos de metal trabecular son una opción versátil (diversos tamaños y formas compatibles con casi todos los sistemas de revisión) y proporcionan un soporte mecánico sin riesgo de reabsorción y colapso. [7][8][9][10][11][12] Las desventajas son su elevado costo económico, no aportar stock óseo, la dificultad para extraerlos si hay una infección que lo requiera y ser altamente irritantes para los tejidos blandos circundantes.…”

Section: Introductionunclassified

Uso de conos de metal trabecular para defectos óseos severos en cirugía de revisión de reemplazo total de rodilla

García-Mansilla

Costantini

Nicolino

et al. 2021

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: Las alternativas reconstructivas para defectos óseos severos en la cirugía de revisión de prótesis son las camisas metafisarias, los conos de metal trabecular y el injerto óseo impactado o estructural. El objetivo del estudio fue analizar la tasa de osteointegración de los conos de metal trabecular en pacientes con cirugía de revisión de prótesis total de rodilla. El objetivo secundario fue analizar los resultados funcionales, las tasas de complicaciones y reoperaciones. Materiales y Métodos: Cohorte retrospectiva de pacientes con conos de metal trabecular colocados en la cirugía de revisión de prótesis y un seguimiento mínimo de 2 años. Se evaluaron las causas de la revisión, cirugías previas, tipo de defecto óseo, cantidad y tipo de conos utilizados, y los diseños de las prótesis. Se realizó una evaluación clínico-radiográfica, se registraron las complicaciones y las revisiones ulteriores. Resultados: Se evaluó a 35 pacientes (49 conos de metal trabecular) en forma retrospectiva, con un seguimiento promedio de 32.1 meses. La mayoría de los defectos eran tibiales AORI 3, seguidos de los femorales tipo 3. La tasa de osteointegración de los conos fue del 94%; la de complicaciones, del 20% y la de reoperaciones, del 8,5%. El KSS objetivo promedio aumentó de 39 en el preoperatorio a 71 en el último control y el puntaje de la EAV promedio fue 8 y 2,5, respectivamente. Conclusión: La excelente tasa de osteointegración (94%) y los buenos resultados clínicos posicionan a los conos de metal trabecular como una alternativa para los defectos óseos severos.

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Trabecular Metal Cones Combined With Short Cemented Stem Allow Favorable Outcomes in Aseptic Revision Total Knee Arthroplasty

Cited by 40 publications

References 39 publications

No difference in long-term micromotion between fully cemented and hybrid fixation in revision total knee arthroplasty: a randomized controlled trial

No difference in long-term micromotion between fully cemented and hybrid fixation in revision total knee arthroplasty: a randomized controlled trial

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

Uso de conos de metal trabecular para defectos óseos severos en cirugía de revisión de reemplazo total de rodilla

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