Medium term clinical outcomes of tibial cones in revision knee arthroplasty
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KNEE ARTHROPLASTY
Medium term clinical outcomes of tibial cones in revision knee arthroplasty Roger Erivan1 · Robert Tracey2,3 · Aurélien Mulliez4 · Guillaume Villatte1 · Wayne Paprosky2,3 Received: 4 October 2019 / Accepted: 15 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Trabecular metal cones are a relatively new option for reconstruction of major bone defects during revision total knee arthroplasty (TKA). The purpose of the present study was to retrospectively assess medium-term results for tibial cones in revision TKA with a severe proximal tibial bone defect. We hypothesized that revision TKA patients with bone defects treated with trabecular metal cones have excellent medium-term clinical and radiological results. Patients and methods A single-center retrospective review included all consecutive cases of tibial revision using trabecular metal cones. All patients with a minimum 2-year follow-up were included in the study. There were no exclusion criteria. The primary endpoint was tibial cone survivorship. The secondary endpoints were revision TKA all-cause survivorship, patientreported outcome measures with a Knee injury and Osteoarthritis Outcome Score (KOOS), SF 12, and radiographic analysis. Results Five of the 57 patients alive at last follow-up (8.77%) had undergone revision (4 for infection and 1 for instability). Complications comprised four cases (7.02%) of infection, 2 cases (3.51%) of tibial and femoral implant aseptic loosening that did not require revision surgery, 1 of which (1.75%) with associated patellar loosening, and 1 case (1.75%) of instability. Kaplan–Meier estimates showed 100% 5-year survivorship with tibial cone revision for aseptic loosening and 93.44% (95% CI 83.47–97.49%) for all-cause revision. Discussion The present study of cones used for tibial revision supports shows excellent results; however, longer and larger follow-up is needed to better assess results in revision TKA. Level of evidence 4, retrospective study Keywords Tibial cone · Trabecular metal · Total knee revision · Aseptic loosening
Introduction Revision total knee arthroplasty (TKA) is the primary treatment for failed primary TKA. The anticipated volume and cost of revision TKA are forecasted to significantly increase in the near future [1]. Results after revision TKA are less * Roger Erivan rerivan@chu‑clermontferrand.fr 1
CNRS, SIGMA Clermont, ICCF, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont‑Ferrand, France
2
Rush University, Chicago, IL, USA
3
Central DuPage Hospital, Northwestern University, Evanston, IL, USA
4
Délégation à la Recherche Clinique et aux Innovations (DRCI), CHU Clermont-Ferrand, 63000 Clermont‑Ferrand, France
predictable than after primary surgery [2]. Assessment and management of bone defects in revision TKA is a challenging problem [3]. Depending on defect severity, improved distal fixation may be needed. Many treatment options are available, without any evidence of superiority [4]. Trabecular met
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