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Tibial, femoral tantalum metaphyseal cones treat bone loss in revision TKA

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Severe tibial and femoral bone loss in cases of revision knee arthroplasty can be treated with a high success rate and low rate of infection through the use of tibial and femoral tantalum metaphyseal cones, according to a recently presented study.

Michael P. Bolognesi, MD, shared his team’s findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

“There are multiple reasons why we are dealing with metaphyseal bone loss, including osteolysis, loosening, infection and iatrogenic reasons,” Bolognesi said. “We are obviously thinking about the big three defects on the femoral and tibial side, and certainly also the bigger 2B tibial defects.”

Bolognesi and his team followed 27 patients with a mean age of 64.6 years who underwent 33 tantalum metaphyseal cone implantations. Reimplantation-infection was the preoperative diagnosis in 13 patients, with loosening being the diagnosis in 10 patients and wear-osteolysis in four.

“The evaluations we went through included pain, function scores, radiographic evaluations and certainly our failure rate — which we decided would be removal or re-revision — with a 3.3-year mean follow-up,” Bolognesi said.

With a mean follow-up of 3.3 years, the researchers found patients reported improved Knee Society pain scores as well as improved function scores. Osseous integration without loosening was found in all 24 tibial cones and 8 of 9 femoral cones, Bolognesi noted.

Overall, Bolognesi said, his team found high success rates and low infection rates in 27 revisions with severe tibial and femoral bone loss.

“How do you manage these large bone defects? There are a number of options,” Bolognesi said. “We hope this study points out this is certainly one of the options you could consider outside of megaprosthesis or an allograft … I think the results bear out this is something to consider.”

“I think this technique is promising with some of these larger defects,” he added. “The studies we have for cones are obviously still smaller than what is out there for allograft cases, and there is no doubt we need longer follow-up for these and similar devices.”

Reference:

• Bolognesi, MP, Lachiewicz PF, Henderson RA, et al. Revision knee arthroplasty using tantalum cones for tibial and femoral bone loss. Paper #246. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.

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