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Use of Porous Tantalum Metaphyseal Cones for Severe Tibial Bone Loss During Revision Total Knee Replacement

Surgical Technique

¹ New England Musculoskeletal Institute, University of Connecticut Health Center, MARB, 4th Floor, 263 Farmington Avenue, Farmington, CT 06034. E-mail address: meneghini{at}uchc.edu
² Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 90-A, pp. 78-84, January 2008

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Zimmer). Also, commercial entities (Zimmer and Stryker) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

METHODS: Porous tantalum metaphyseal cones were implanted during fifteen revision total knee replacements in eight women and seven men who had an average age of 68.1 years at the time of the procedure. The patients had had an average of 3.5 prior total knee replacements. According to the Anderson Orthopaedic Research Institute bone defect classification, eight knees had a Type-3 defect and seven knees had a Type-2B bone defect. All patients were followed clinically and radiographically.

RESULTS: The patients were followed for an average of thirty-four months (range, twenty-four to forty-seven months). Overall, the average Knee Society clinical scores improved from 52 points preoperatively to 85 points at the time of the final follow-up. At the final follow-up evaluation, all fifteen porous metaphyseal cones showed evidence of osseointegration with reactive osseous trabeculation at points of contact with the tibia. There was no evidence of loosening or migration of any of these tibial reconstructions at the time of final follow-up.

CONCLUSIONS: At the time of short-term follow-up, the porous tantalum metaphyseal tibial cones effectively provided structural support for the tibial implants in this series. The potential for long-term biologic fixation may provide durability for these tibial reconstructions. Long-term follow-up and comparison with alternative reconstructive techniques will be required to evaluate the true effectiveness of this treatment approach.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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