Meneghini R Michael, Lewallen David G, Hanssen Arlen D
Joint Replacement Surgeons of Indiana Research Foundation, St. Vincent Center for Joint Replacement, 8402 Harcourt Road, Suite 128, Indianapolis, IN 46260, USA.
J Bone Joint Surg Am. 2008 Jan;90(1):78-84. doi: 10.2106/JBJS.F.01495.
The best treatment method for large tibial bone defects during revision knee replacement has not been established. The purpose of this study was to determine the initial results obtained with a unique reconstructive implant, the porous tantalum metaphyseal cone, designed as an alternative treatment for severe tibial bone loss following total knee arthroplasty.
Porous tantalum metaphyseal cones were implanted during fifteen revision total knee replacements in eight women and seven men who had an average age of 68.1 years at the time of the procedure. The patients had had an average of 3.5 prior total knee replacements. According to the Anderson Orthopaedic Research Institute bone defect classification, eight knees had a Type-3 defect and seven knees had a Type-2B bone defect. All patients were followed clinically and radiographically.
The patients were followed for an average of thirty-four months (range, twenty-four to forty-seven months). Overall, the average Knee Society clinical scores improved from 52 points preoperatively to 85 points at the time of the final follow-up. At the final follow-up evaluation, all fifteen porous metaphyseal cones showed evidence of osseointegration with reactive osseous trabeculation at points of contact with the tibia. There was no evidence of loosening or migration of any of these tibial reconstructions at the time of final follow-up.
At the time of short-term follow-up, the porous tantalum metaphyseal tibial cones effectively provided structural support for the tibial implants in this series. The potential for long-term biologic fixation may provide durability for these tibial reconstructions. Long-term follow-up and comparison with alternative reconstructive techniques will be required to evaluate the true effectiveness of this treatment approach.
膝关节置换翻修术中大型胫骨骨缺损的最佳治疗方法尚未确定。本研究的目的是确定一种独特的重建植入物——多孔钽干骺端锥体的初步结果，该植入物被设计为全膝关节置换术后严重胫骨骨丢失的替代治疗方法。
在15例膝关节置换翻修术中植入多孔钽干骺端锥体，患者包括8名女性和7名男性，手术时平均年龄为68.1岁。患者此前平均接受过3.5次全膝关节置换。根据安德森骨科研究所骨缺损分类，8个膝关节为3型缺损，7个膝关节为2B型骨缺损。所有患者均接受临床和影像学随访。
患者平均随访34个月（范围为24至47个月）。总体而言，膝关节协会临床评分平均从术前的52分提高到最后一次随访时的85分。在最后一次随访评估时，所有15个多孔干骺端锥体均显示在与胫骨接触点处有骨整合及反应性骨小梁形成的迹象。在最后一次随访时，这些胫骨重建物均未出现松动或移位迹象。
在短期随访时，多孔钽胫骨干骺端锥体在本系列中有效地为胫骨植入物提供了结构支撑。长期生物固定的潜力可能为这些胫骨重建提供耐久性。需要进行长期随访并与其他重建技术进行比较，以评估这种治疗方法的真正有效性。
