Shichman Ittai, Oakley Christian, Willems Jore H, van Hellemondt Gijs G, Heesterbeek Petra, Rozell Joshua, Marwin Scott, Schwarzkopf Ran
Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, New York, NY, 10003, USA.
Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Arch Orthop Trauma Surg. 2023 Mar;143(3):1537-1547. doi: 10.1007/s00402-022-04645-5. Epub 2022 Oct 15.
Loosening and migration are common modes of aseptic failure following complex revision total knee arthroplasty (rTKA). Metaphyseal cones allow surgeons to negotiate the loss of femoral and tibial bone stock while obtaining stable bony fixation. This study examines the mid-term functional and radiographic outcomes in patients undergoing rTKA utilizing a novel metaphyseal cone system with stems of variable length and fixation methods.
This two-center retrospective study examined all patients who underwent rTKA with a novel porous, titanium tibial or femoral cone in combination with a stem of variable length and fixation who had a minimum follow-up of 2-years. Outcome analysis was separated into tibial and femoral cones as well as the stem fixation method (hybrid vs. fully cemented).
Overall, 123 patients who received 156 cone implants were included (74 [60.2%] tibial only, 16 [13.0%] femoral only, and 33 [26.8%] simultaneous tibial and femoral) with a mean follow-up of 2.76 ± 0.66 years. At 2-years of follow-up the total cohort demonstrated 94.3% freedom from all-cause re-revisions, 97.6% freedom from aseptic re-revisions, and 99.4% of radiographic cone osteointegration. All-cause revision rates did not differ between stem fixation techniques in both the tibial and femoral cone groups.
The use of a novel porous titanium femoral and tibial metaphyseal cones combined with stems in patients with moderate to severe bone defects undergoing complex revision total knee arthroplasty confers excellent results independent of stem fixation technique.
IV, case series.
在复杂的全膝关节置换翻修术（rTKA）后，假体松动和移位是无菌性失败的常见模式。干骺端锥体可使外科医生在处理股骨和胫骨骨量丢失的同时获得稳定的骨质固定。本研究探讨了采用新型干骺端锥体系统（其柄部长度可变且固定方法多样）进行rTKA的患者的中期功能和影像学结果。
这项双中心回顾性研究检查了所有接受rTKA的患者，这些患者使用了新型多孔钛质胫骨或股骨锥体，并结合了长度可变的柄部和固定方式，且至少随访2年。结果分析分为胫骨和股骨锥体以及柄部固定方法（混合固定与全骨水泥固定）。
总体而言，纳入了123例接受156个锥体植入物的患者（仅胫骨74例[60.2%]，仅股骨16例[13.0%]，同时进行胫骨和股骨置换33例[26.8%]），平均随访时间为2.76±0.66年。在随访2年时，整个队列显示94.3%的患者无因任何原因进行再次翻修，97.6%的患者无无菌性再次翻修，99.4%的锥体实现影像学骨整合。在胫骨和股骨锥体组中，柄部固定技术之间的全因翻修率没有差异。
对于中度至重度骨缺损患者，在进行复杂的全膝关节置换翻修术时，使用新型多孔钛质股骨和胫骨干骺端锥体并结合柄部，无论柄部固定技术如何，均能取得优异的效果。
IV，病例系列。
