High survival rate at mid-term follow up of porous tantalum cones for bone defects in revision total knee replacement: A 3-11 years follow up report

Background: Large metaphyseal bone losses are commonly encountered in revision total knee arthroplasty (rTKA). Anderson Orthopaedic Research Institute (AORI) type 2 and 3 defects generally require some metaphyseal fixation or augmentation. This study evaluates the midterm results of Porous Tantalum Trabecular Metal™ (TM) cones in revision TKA addressing severe bone loss. Methods: Patients who underwent revision TKA using metaphyseal cones and a varus-valgus constrained (VVC) implant from January 2010 to January 2018 at our institution were identified from a prospective research database. Pre-operative patient characteristics and operative data were reviewed. Postoperative outcomes were compared with pre-operative values. Primary study aims were to evaluate outcomes, including complications and re-operations, radiographic assessment of cones osteointegration, and survivorship. Results: A total of 101 knees (101 patients) underwent revision TKA with 139 metaphyseal cones (80 tibial, 59 femoral). AORI defect classification was assessed intraoperatively. All patients were available for a minimum of 2 years of clinical and radiographic follow up. Mean follow up was 7.5 years (range 3-11 years). All patients showed significant improvement of clinical outcomes. Fifteen knees required re-operation and nine required revision of the implants, most commonly for recurrent infection (six of nine revisions) with cones removal. Kaplan-Meier survival analysis show a survival rate of 93.9% at 2 years and a survival rate of 90.2% at 5 and 11 years. Conclusions: This large series illustrates the utility of porous metaphyseal cones in revision TKA with promising clinical and radiographic results and a high survival rate at mid-term follow up.