Can Tantalum Cones Provide Fixation in Complex Revision Knee Arthroplasty?

• Published in: Clinical orthopaedics and related research 2012-01, Vol.470 (1), p.199-204
• Main Authors: Lachiewicz, Paul F., Bolognesi, Michael P., Henderson, Robert A., Soileau, Elizabeth S., Vail, Thomas Parker
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Cohort Studies; Conservative Orthopedics; Female; Follow-Up Studies; Humans; Joint Instability - prevention & control; Knee; Knee Prosthesis; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osseointegration - drug effects; Pain Measurement; Preoperative Care - methods; Prosthesis Failure; Range of Motion, Articular - physiology; Recovery of Function; Reoperation - methods; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Papers Presented at the Annual Meetings of The Knee Society; Tantalum - therapeutic use; Treatment Outcome
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-011-1888-9

Background The best method for managing large bone defects during revision knee arthroplasty is unknown. Metaphyseal fixation using porous tantalum cones has been proposed for severe bone loss. Whether this approach achieves osseointegration with low complication rates is unclear. Questions/purposes We therefore asked: (1) What is the risk of infection in revision knee arthroplasty with large bone defects reconstructed with porous tantalum cones? (2) What is the rate of osseointegration with these cones? (3) What is the rate of loosening and reoperation? (4) Is knee function restored? Methods We retrospectively reviewed 27 patients who had 33 tantalum cones (nine femoral, 24 tibial) implanted during 27 revision knee arthroplasties. There were 14 women and 13 men with a mean age of 64.6 years. Preoperative diagnosis was reimplantation for infection in 13 knees, aseptic loosening in 10, and wear-osteolysis in four. Patients were evaluated clinically and radiographically using the score systems of the Knee Society and followed for a minimum of 2 years (mean, 3.3 years; range, 2–5.7 years). Results One knee with two cones was removed for infection. All but one cone showed osseointegration. One knee was revised for femoral cone and component loosening. There was one reoperation for femoral shaft fracture and one for superficial dehiscence. The mean Knee Society pain score improved from 40 points preoperatively to 79 points postoperatively. The mean function score improved from 19 points to 47 points. Conclusions Our observations suggest metaphyseal fixation with tantalum cones can be achieved. Longer-term followup is required to determine whether the fixation is durable. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.