42.
Use of Trabecular Metal Cones (TM Cone) for Reconstruction of
Severe Bone loss at the Proximal Tibia in Revision Total Knee
Arthroplasty. 35 cases followed 5-72 months.
nikolaj winther , claus lindkær, michael mørk petersen, henrik Schrøder
orthopedic Righospitalet; orthopeadics, bispebjerg hospital; orthopeadic,
Rigshospitalet; orthopeadic, Rigshospitalet
Background:
Management of bone loss at the proximal tibia at the time of
revision total knee arthroplasty (rTKA) can be challenging. The use of a
porous tantalum TM cones is a relatively new option for treatment of severe
bone loss.
Purpose / Aim of Study:
To evaluate the results of rTKA with the use of TM
cones performed during a 6- year period.
Materials and Methods:
From October 2005 to May 2011, 310 patients had a
rTKA in our hospital. 35 patients (11%) received a TM Cone for
reconstruction of severe bone loss at the proximal tibia. All patients were
evaluated by the Knee Society Score (KSS). Bone loss at the proximal tibia
was classified according to the Anderson Orthopaedic Research Institute
(
AORI) score from the pre- and postoperative x-rays. In addition bone loss was
classified as contained/non- contained, and as +/- ”ice cream cone” defect. The
prostheses used were 15 RHK, 14 LCCK , and 6 LPS (Nexgen, Zimmer), and
in all cases, press-fit stems and hybrid cementation were used. Totally, 13/35
defects were non- contained, and 8/35 had ice cream cone defects.
Findings / Results:
Preoperative x-rays showed 9 knees with T1 bone defect,
19
knees with T2 defect and 8 knees were classified as T3 bone defects. Knee
and function scores improved. Two patients had re- revision because of
infection. During re- revision the TM cones were well-fixed. None of the
remaining patients (n = 32) have been revised. All follow-up x-rays showed no
signs of radiologically loosening.
Conclusions:
35
total knee revision arthroplasties with a tibial TM Cone were
followed for 5- 72 months. No loosening was found, and we consider the TM
Cone to be a reliable tool in dealing with large bone loss.
