PDF herunterladen
CC BY-NC-ND 4.0 · Joints 2018; 06(01): 058-064
DOI: 10.1055/s-0037-1608950
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Are Trabecular Metal Cones a Valid Option to Treat Metaphyseal Bone Defects in Complex Primary and Revision Knee Arthroplasty?

Tommaso Bonanzinga
1   Istituto Clinico Humanitas, Rozzano, Milano, Italy
2   Dipartimento Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
3   Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
,
Thorsten Gehrke
4   HELIOS ENDO Klinik, Hamburg, Germany
,
Akos Zahar
4   HELIOS ENDO Klinik, Hamburg, Germany
,
Stefano Zaffagnini
2   Dipartimento Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
3   Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
5   Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Bologna, Italy
,
Maurilio Marcacci
1   Istituto Clinico Humanitas, Rozzano, Milano, Italy
6   Humanitas University, Rozzano, Milano, Italy
,
Carl Haasper
2   Dipartimento Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

27. Juni 2017

29. Oktober 2017

Publikationsdatum:
14. Dezember 2017 (online)

   Lizenzen und Reprints

Abstract

Purpose Metaphyseal bone defects are a challenge in complex primary and revision total knee arthroplasty (TKA). Recently, several studies have been published with promising results about the use of Trabecular Metal (TM) cones to address bone defects. The aim of this study is to review the literature to assess the efficacy of TM cones to address metaphyseal bone loss.

Methods A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: “metaphyseal,” “cones,” “tantalum,” “knee,” and “revision.” Only papers reporting clinical data about the use of trabecular metal cones were included in the analysis. In vitro studies, case reports, surgical technique, or other studies where it was not possible to collect clinical data were excluded. Patients characteristics, details of the surgical procedures, outcome, and complications were collected from each included study.

Results No controlled studies were available in the literature and all the papers were case series. In 16 studies included, the records of 442 patients with 447 implants and 523 TM cones were reported. The mean follow-up was 42 months (range: 5–105) for 360 procedures. Among 437 procedures, 30.4% were septic revisions. The Anderson Orthopaedic Research Institute (AORI) classification was available for 352 defects: 13 type 1, 69 type 2A, 115 type 2B, and 155 type 3. To manage these 352 defects, 360 TM cones were implanted. Intraoperative fractures occurred 13 times (10 femoral/3 tibial), 6 required surgical fixation. The overall infection rate was 7.38%, and the infection rate for the aseptic procedures was 0.99%. An aseptic exchange was performed 13 times, among these procedures two TM cones were loose. Signs of loosening were found just in 1.3% of the 523 TM cones implanted (5 femoral/2 tibial) during 447 procedures.

Conclusion The TM cones are an effective solution to manage bone defects in complex primary and revision TKA at intermediate follow-up. The incidence of complications was low; however, the femoral metaphysis proved to be more susceptible to complications.

Level of Evidence Level IV, systematic review of level IV studies.

Keywords

metaphyseal - cones - tantalum - knee - revision
 

  • References

  • 1 Hilgen V, Citak M, Vettorazzi E. , et al. 10-year results following impaction bone grafting of major bone defects in 29 rotational and hinged knee revision arthroplasties: a follow-up of a previous report. Acta Orthop 2013; 84 (04) 387-391
    CrossrefPubMedGoogle Scholar
  • 2 Morgan-Jones R, Oussedik SIS, Graichen H, Haddad FS. Zonal fixation in revision total knee arthroplasty. Bone Joint J 2015; 97-B (02) 147-149
    CrossrefPubMedGoogle Scholar
  • 3 Engh GA, Ammeen DJ. Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect 1999; 48: 167-175
    PubMedGoogle Scholar
  • 4 Bush JL, Wilson JB, Vail TP. Management of bone loss in revision total knee arthroplasty. Clin Orthop Relat Res 2006; 452 (452) 186-192
    CrossrefPubMedGoogle Scholar
  • 5 Beckmann NA, Mueller S, Gondan M, Jaeger S, Reiner T, Bitsch RG. Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones-a systematic review. J Arthroplasty 2015; 30 (02) 249-253
    CrossrefPubMedGoogle Scholar
  • 6 LaBerge M, Bobyn JD, Rivard CH, Drouin G, Duval P. Study of soft tissue ingrowth into canine porous coated femoral implants designed for osteosarcomas management. J Biomed Mater Res 1990; 24 (07) 959-971
    CrossrefPubMedGoogle Scholar
  • 7 Cohen R. A porous tantalum trabecular metal: basic science. Am J Orthop 2002; 31 (04) 216-217
    PubMedGoogle Scholar
  • 8 Levine B, Sporer S, Della Valle CJ, Jacobs JJ, Paprosky W. Porous tantalum in reconstructive surgery of the knee: a review. J Knee Surg 2007; 20 (03) 185-194
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 1999; 81 (05) 907-914
    CrossrefPubMedGoogle Scholar
  • 10 Bobyn JD, Toh KK, Hacking SA, Tanzer M, Krygier JJ. Tissue response to porous tantalum acetabular cups: a canine model. J Arthroplasty 1999; 14 (03) 347-354
    CrossrefPubMedGoogle Scholar
  • 11 Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM Statement. Onkologie 2000; 23 (06) 597-602
    PubMedGoogle Scholar
  • 12 Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am 2003; 85-A (01) 1-3
    PubMedGoogle Scholar
  • 13 Radnay CS, Scuderi GR. Management of bone loss: augments, cones, offset stems. Clin Orthop Relat Res 2006; 446 (446) 83-92
    CrossrefPubMedGoogle Scholar
  • 14 Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am 2008; 90 (01) 78-84
    CrossrefPubMedGoogle Scholar
  • 15 Long WJ, Scuderi GR. Porous tantalum cones for large metaphyseal tibial defects in revision total knee arthroplasty: a minimum 2-year follow-up. J Arthroplasty 2009; 24 (07) 1086-1092
    CrossrefPubMedGoogle Scholar
  • 16 Howard JL, Kudera J, Lewallen DG, Hanssen AD. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg Am 2011; 93 (05) 478-484
    CrossrefPubMedGoogle Scholar
  • 17 Lachiewicz PF, Bolognesi MP, Henderson RA, Soileau ES, Vail TP. Can tantalum cones provide fixation in complex revision knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (01) 199-204
    CrossrefPubMedGoogle Scholar
  • 18 Schmitz H-CR, Klauser W, Citak M, Al-Khateeb H, Gehrke T, Kendoff D. Three-year follow up utilizing tantal cones in revision total knee arthroplasty. J Arthroplasty 2013; 28 (09) 1556-1560
    CrossrefPubMedGoogle Scholar
  • 19 Rao BM, Kamal TT, Vafaye J, Moss M. Tantalum cones for major osteolysis in revision knee replacement. Bone Joint J 2013; 95-B (08) 1069-1074
    CrossrefPubMedGoogle Scholar
  • 20 Villanueva-Martínez M, De la Torre-Escudero B, Rojo-Manaute JM, Ríos-Luna A, Chana-Rodriguez F. Tantalum cones in revision total knee arthroplasty. A promising short-term result with 29 cones in 21 patients. J Arthroplasty 2013; 28 (06) 988-993
    CrossrefPubMedGoogle Scholar
  • 21 Derome P, Sternheim A, Backstein D, Malo M. Treatment of large bone defects with trabecular metal cones in revision total knee arthroplasty: short term clinical and radiographic outcomes. J Arthroplasty 2014; 29 (01) 122-126
    CrossrefPubMedGoogle Scholar
  • 22 Mozella Ade P, Olivero RR, Alexandre H, Cobra AB. Use of a trabecular metal cone made of tantalum, to treat bone defects during revision knee arthroplasty. Rev Bras Ortop 2014; 49 (03) 245-251
    CrossrefPubMedGoogle Scholar
  • 23 Jensen CL, Winther N, Schrøder HM, Petersen MM. Outcome of revision total knee arthroplasty with the use of trabecular metal cone for reconstruction of severe bone loss at the proximal tibia. Knee 2014; 21 (06) 1233-1237
    CrossrefPubMedGoogle Scholar
  • 24 De Martino I, De Santis V, Sculco PK, D'Apolito R, Assini JB, Gasparini G. Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res 2015; 473 (10) 3176-3182
    CrossrefPubMedGoogle Scholar
  • 25 Boureau F, Putman S, Arnould A, Dereudre G, Migaud H, Pasquier G. Tantalum cones and bone defects in revision total knee arthroplasty. Orthop Traumatol Surg Res 2015; 101 (02) 251-255
    CrossrefPubMedGoogle Scholar
  • 26 Brown NM, Bell JA, Jung EK, Sporer SM, Paprosky WG, Levine BR. The use of trabecular metal cones in complex primary and revision total knee arthroplasty. J Arthroplasty 2015; 30 (9, Suppl): 90-93
    CrossrefPubMedGoogle Scholar
  • 27 Bédard M, Cabrejo-Jones K, Angers M, Pelletier-Roy R, Pelet S. The effect of porous tantalum cones on mechanical alignment and canal-fill ratio in revision total knee arthroplasty performed with uncemented stems. J Arthroplasty 2015; 30 (11) 1995-1998
    CrossrefPubMedGoogle Scholar
  • 28 Kamath AF, Lewallen DG, Hanssen AD. Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. J Bone Joint Surg Am 2015; 97 (03) 216-223
    CrossrefPubMedGoogle Scholar
  • 29 Bobyn JD, Hacking SA, Krygier JJ, Harvey EJ, Little DG, Tanzer M. Zoledronic acid causes enhancement of bone growth into porous implants. J Bone Joint Surg Br 2005; 87 (03) 416-420
    PubMedGoogle Scholar
  • 30 Hacking SA, Bobyn JD, Toh K, Tanzer M, Krygier JJ. Fibrous tissue ingrowth and attachment to porous tantalum. J Biomed Mater Res 2000; 52 (04) 631-638
    CrossrefPubMedGoogle Scholar
  • 31 Brooks PJ, Walker PS, Scott RD. Tibial component fixation in deficient tibial bone stock. Clin Orthop Relat Res 1984; (184) 302-308
    PubMedGoogle Scholar
  • 32 Jafari SM, Bender B, Coyle C, Parvizi J, Sharkey PF, Hozack WJ. Do tantalum and titanium cups show similar results in revision hip arthroplasty?. Clin Orthop Relat Res 2010; 468 (02) 459-465
    CrossrefPubMedGoogle Scholar
  • 33 Dennis DA. The structural allograft composite in revision total knee arthroplasty. J Arthroplasty 2002; 17 (04) (Suppl. 01) 90-93
    PubMedGoogle Scholar
  • 34 De Martino I, Sculco PK. In response to “treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones—a systematic review”. J Arthroplasty 2015; 30 (07) 1287-1289
    CrossrefPubMedGoogle Scholar
  • 35 Patel JV, Masonis JL, Guerin J, Bourne RB, Rorabeck CH. The fate of augments to treat type-2 bone defects in revision knee arthroplasty. J Bone Joint Surg Br 2004; 86 (02) 195-199
    CrossrefPubMedGoogle Scholar
  • 36 Hockman DE, Ammeen D, Engh GA. Augments and allografts in revision total knee arthroplasty: usage and outcome using one modular revision prosthesis. J Arthroplasty 2005; 20 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 37 Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 2016; 98-B (1, Suppl A): 120-124
    CrossrefPubMedGoogle Scholar