Management of large bone defects around the knee using porous tantalum trabecular metal cones during complex primary and revision total knee arthroplasty

Chronic inflammation and bone defects after total knee arthroplasty are a challenge for the orthopedic surgeon. There have been few reports on application of a three-dimensional (3D) printed porous tantalum prosthesis in such situations. We report an 83-year-old female patient who presented to our clinic with consistent pain of the left knee for 10 years and a severe decline in mobility for 2 years. Chronic inflammation, loosening of a tibial prosthesis with a bone defect, and severe osteoporosis were diagnosed. The patient was treated with computer designed and manufactured, personalized, 3D printed porous pure tantalum pad-assisted left total knee arthroplasty. The surgery went smoothly and the patient achieved a satisfactory recovery after surgery. A 3D printed porous tantalum prosthesis can be used to reconstruct tibial bone defects in patients with chronic inflammation after joint replacement surgeries.

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The Effect of Porous Tantalum Cones on Mechanical Alignment and Canal-Fill Ratio in Revision Total Knee Arthroplasty Performed with Uncemented Stems

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.05.016 ◽

2015 ◽

Vol 30 (11) ◽

pp. 1995-1998 ◽

Cited By ~ 6

Author(s):

Martin Bédard ◽

Katherine Cabrejo-Jones ◽

Michèle Angers ◽

Rémi Pelletier-Roy ◽

Stéphane Pelet

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Mechanical Alignment ◽

Porous Tantalum ◽

Fill Ratio ◽

Total Knee

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Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-customized Three-dimensional-printed Metaphyseal Cones in Revision Total Knee Arthroplasty

10.21203/rs.3.rs-84721/v1 ◽

2020 ◽

Author(s):

Yang Li ◽

Xinguang Wang ◽

Hua Tian

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Three Dimensional ◽

Bone Defects ◽

Revision Total Knee Arthroplasty ◽

3D Printed ◽

Total Knee ◽

The Mean ◽

Highly Porous

Abstract Background: The reconstruction of massive bone defects is one of the main challenges in revision total knee arthroplasty (RTKA). Although several methods are available, each of them has its prominent shortcomings. The purpose of this study is to review the clinical outcomes of RTKA with massive proximal tibial bone defects using patient-customized three-dimensional (3D)-printed highly porous metaphyseal cones.Methods: We retrospectively reviewed seven RTKAs with Anderson Orthopaedic Research Institute (AORI) type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones, which have been performed at a single institution between 2016 and 2018. Results: The mean age at diagnosis of the patients was 68 years old (61-77). The mean length of follow-up was 25.3 months (19-36). At the latest follow-up, no aseptic loosening or prosthetic joint infection has been determined. The mean HSS increased from 49 (39-63) to 78 (70-83) (P<0.01); the mean WOMAC increased from 59 (46-73) to 26 (12-38) (P<0.01). All patients obtained the range of motion and mechanical alignment improvement postoperatively.Conclusion: The patient-customized 3D-printed metaphyseal cone could be a promising technique in addressing severe tibial defects in RTKA. Our study shows encouraging short-term clinical and radiological outcomes with no aseptic loosening, periprosthetic infection, or fracture. Nevertheless, further follow-up and the expansion of sample size are needed to demonstrate the advantage of this innovative technique fully.

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Excellent mid-term osseointegration and implant survival using metaphyseal sleeves in revision total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-05865-1 ◽

2020 ◽

Vol 28 (12) ◽

pp. 3843-3848 ◽

Cited By ~ 1

Author(s):

Sebastian M. Klim ◽

Florian Amerstorfer ◽

Gerwin A. Bernhardt ◽

Patrick Sadoghi ◽

Georg Hauer ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Aseptic Loosening ◽

Treatment Option ◽

Knee Arthroplasty ◽

Bone Defects ◽

Revision Total Knee Arthroplasty ◽

Sf 36 ◽

Total Knee ◽

Mid Term Results

Abstract Purpose Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. Methods Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone–sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. Results No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. Conclusion No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. Level of evidence Retrospective cohort study, level III.

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