Short-term Outcomes of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty

• Published in: Orthopedics (Thorofare, N.J.) Vol. 44; no. 1; pp. 43 - 47
• Main Authors: Remily, Ethan A, Dávila Castrodad, Iciar M, Mohamed, Nequesha S, Wilkie, Wayne A, Kelemen, Margaret N, Delanois, Ronald E
• Format: Journal Article
• Language: English
• Published: United States Slack, Inc 01.01.2021; SLACK INCORPORATED
• Subjects: Alcohol; Body mass index; Comorbidity; Debridement; Defects; Demographics; Drug abuse; Fractures; Health aspects; Infections; Joint replacement surgery; Joint surgery; Length of stay; Medical personnel; Orthopedics; Patients; Prostheses; Statistical analysis; Titanium; Titanium castings; Transplants & implants; United States
• ISSN: 0147-7447; 1938-2367
• DOI: 10.3928/01477447-20201202-04

Recently, 3-dimensional (3D) printing technology has been used in the development of titanium metaphyseal cones to manage severe bone loss in revision total knee arthroplasty (rTKA). This study assessed (1) radiographs; (2) functional outcomes; (3) complications; and (4) 2-year implant survivorship in patients receiving 3D-printed titanium metaphyseal cones for moderate-to-severe tibial and femoral bone loss in rTKA. A single institution, retrospective chart review was performed for patients with large bone defects treated with a 3D-printed femoral or tibial titanium metaphyseal cone between 2015 and 2017 during rTKA (N=54). Paired sample t tests analyzed Knee Society Scores (KSS). Kaplan-Meier analyses determined implant survivorship when the endpoint was cone revision for aseptic loosening, cone revision for any reason, and reoperation for any reason. The authors found that 51 (98.1%) of 52 available radiographs demonstrated well-fixed components without any evidence of loosening or migration. Mean postoperative KSS scores were significantly higher when compared with preoperative scores (80.4 vs 52.0; P>.001). One patient experienced aseptic loosening of their cone. Seven additional cones were explanted as a consequence of reinfection, 1 of which was removed prior to arthrodesis. Cone survivorship was 98.5% when the endpoint was cone revision due to aseptic loosening, 88.2% when cone revision was due to any reason, and 77.9% for any reoperation. Metaphyseal cones appear to be well-suited for large bone defects during rTKA and the authors' findings suggest that cones may be a viable option for metaphyseal fixation during rTKA. Future studies should focus on their durability during a longer time period. [Orthopedics. 2021;44(1):43-47.].