Bonanzinga Tommaso, Gehrke Thorsten, Zahar Akos, Zaffagnini Stefano, Marcacci Maurilio, Haasper Carl
Istituto Clinico Humanitas, Rozzano, Milano, Italy.
Dipartimento Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy.
Joints. 2017 Dec 14;6(1):58-64. doi: 10.1055/s-0037-1608950. eCollection 2018 Mar.
Metaphyseal bone defects are a challenge in complex primary and revision total knee arthroplasty (TKA). Recently, several studies have been published with promising results about the use of Trabecular Metal (TM) cones to address bone defects. The aim of this study is to review the literature to assess the efficacy of TM cones to address metaphyseal bone loss. A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "metaphyseal," "cones," "tantalum," "knee," and "revision." Only papers reporting clinical data about the use of trabecular metal cones were included in the analysis. In vitro studies, case reports, surgical technique, or other studies where it was not possible to collect clinical data were excluded. Patients characteristics, details of the surgical procedures, outcome, and complications were collected from each included study. No controlled studies were available in the literature and all the papers were case series. In 16 studies included, the records of 442 patients with 447 implants and 523 TM cones were reported. The mean follow-up was 42 months (range: 5-105) for 360 procedures. Among 437 procedures, 30.4% were septic revisions. The Anderson Orthopaedic Research Institute (AORI) classification was available for 352 defects: 13 type 1, 69 type 2A, 115 type 2B, and 155 type 3. To manage these 352 defects, 360 TM cones were implanted. Intraoperative fractures occurred 13 times (10 femoral/3 tibial), 6 required surgical fixation. The overall infection rate was 7.38%, and the infection rate for the aseptic procedures was 0.99%. An aseptic exchange was performed 13 times, among these procedures two TM cones were loose. Signs of loosening were found just in 1.3% of the 523 TM cones implanted (5 femoral/2 tibial) during 447 procedures. The TM cones are an effective solution to manage bone defects in complex primary and revision TKA at intermediate follow-up. The incidence of complications was low; however, the femoral metaphysis proved to be more susceptible to complications. Level IV, systematic review of level IV studies.
干骺端骨缺损是复杂的初次和翻修全膝关节置换术（TKA）中的一项挑战。最近，已有多项关于使用小梁金属（TM）锥形物来解决骨缺损问题的研究发表，且取得了令人满意的结果。本研究旨在回顾相关文献，以评估TM锥形物解决干骺端骨质流失问题的疗效。
使用以下关键词的各种组合，对PubMed、Medline、CINAHL、Cochrane、Embase和谷歌学术数据库进行了全面检索：“干骺端”“锥形物”“钽”“膝关节”和“翻修”。分析中仅纳入了报告使用小梁金属锥形物临床数据的论文。体外研究、病例报告、手术技术或其他无法收集临床数据的研究均被排除。从每项纳入研究中收集患者特征、手术细节、结果和并发症情况。
文献中没有对照研究，所有论文均为病例系列研究。在纳入的16项研究中，报告了442例患者植入447枚植入物和523个TM锥形物的记录。360例手术的平均随访时间为42个月（范围：5 - 105个月）。在437例手术中，30.4%为感染性翻修手术。352处骨缺损可进行安德森矫形研究所（AORI）分类：13处为1型，69处为2A型，115处为2B型，155处为3型。为处理这352处骨缺损，共植入了360个TM锥形物。术中发生骨折13次（10例股骨/3例胫骨），其中6例需要手术固定。总体感染率为7.38%，无菌手术的感染率为0.99%。进行了13次无菌翻修手术，其中2个TM锥形物出现松动。在447例手术中，仅1.3%的523个植入TM锥形物（5例股骨/2例胫骨）出现松动迹象。
在中期随访中，TM锥形物是解决复杂初次和翻修TKA中骨缺损的有效方法。并发症发生率较低；然而，股骨干骺端更容易出现并发症。
IV级，IV级研究的系统评价。
