Porous tantalum tibial metaphyseal cones offer durable long-term fixation for revision TKA
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Key takeaways:
- Porous tantalum metaphyseal cones provided durable fixation for patients undergoing revision total knee arthroplasty.
- The cones yielded reliable survivorship at 10 years and low rates of implant removal.
According to published results, use of porous tantalum tibial metaphyseal cones in revision total knee arthroplasty was associated with durable survivorship at 10 years and low rates of implant removal.
Researchers at the Mayo Clinic in Rochester retrospectively analyzed data from 228 revision TKAs performed with porous tantalum tibial metaphyseal cones and stemmed tibial components at a single institution between 2004 and 2011.
According to the study, the mean patient age was 65 years. Mean follow-up was 6.3 years. Postoperative outcome measures included implant survivorship, complication rate, Knee Society score (KSS) and radiographic assessment.
Overall, researchers found durable long-term survivorship rates for patients who received porous tantalum tibial metaphyseal cones. At 10 years, survivorship free of aseptic loosening resulting in cone removal was 97%; survivorship free of any cone removal was 88%; survivorship free of any re-revision was 66%; and survivorship free of any reoperation was 58%. Researchers noted the most common reasons for re-revision were periprosthetic joint infection, instability and aseptic loosening of the femoral component.
At 10 years, researchers found a nonoperative complication rate of 24%. They noted mean KSS improved from 38 before surgery to 69 at 10-year follow-up. On radiographic analysis, researchers found evidence of partial, progressive tibial radiolucencies in eight knees.
“When addressing tibial bone loss and seeking stable fixation in revision TKA, this study shows that porous tantalum metaphyseal cones provide a highly effective and durable long-term solution,” the researchers wrote in the study.
Perspective
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Bone loss at the time of revision TKA can compromise implant fixation and impact long-term durability. That is why there has been a great deal of attention directed to the zonal concept of metaphyseal and diaphyseal fixation. While diaphyseal fixation with either cemented or press-fit stem extensions provide secure distal fixation, proximal metaphyseal defects tend to be more challenging.
The introduction of porous tantalum cones that are appropriately shaped and sized affords greater versatility and provides a predictable and durable fixation option for metaphyseal defects. Short-term studies have demonstrated the utility of porous tantalum cones in achieving bone ingrowth with stable fixation. In a retrospective review of 228 revision TKAs utilizing porous tantalum tibial cones, Matthew L. Hadley, MD, and colleagues in The Journal of Arthroplasty reported that the 10-year survivorship free of aseptic loosening was 97%, free of any cone removal was 88%, free of any re-revision was 66% and free of any reoperation was 58%.
This recent study revealed that porous tantalum metaphyseal cones provide an effective and durable long-term solution for tibial defects in revision TKA. As the annual number of patients undergoing revision TKA continues to increase, porous tantalum cones will continue to be an integral component for tibial zonal fixation.
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