Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2024 Aug;39(8S1):S263-S269. doi: 10.1016/j.arth.2024.04.059. Epub 2024 Apr 25.
Highly porous metal tibial metaphyseal cones (TMCs) are commonly utilized in revision total knee arthroplasty (TKA) to address bone loss and obtain biologic fixation. Mid-term (5 to 10 year) studies have previously demonstrated excellent survivorship and high rates of osseointegration, but longer-term studies are lacking. We aimed to assess long-term (≥ 10 year) implant survivorship, complications, and clinical and radiographic outcomes after revision TKA with TMCs.
Between 2004 and 2011, 228 revision TKAs utilizing porous tantalum TMCs with stemmed tibial components were performed at a single institution and were retrospectively reviewed. The mean age at revision was 65 years, the mean body mass index was 33, and 52% were women. Implant survivorship, complications, and clinical and radiographic outcomes were assessed. The mean follow-up was 6.3 years.
The 10-year survivorship free of aseptic loosening leading to TMC removal was 97%, free of any TMC removal was 88%, free of any re-revision was 66%, and free of any reoperation was 58%. The most common indications for re-revision were periprosthetic joint infection, instability, and aseptic femoral component loosening. The 10-year nonoperative complication rate was 24%. The mean Knee Society scores increased from 38 preoperatively to 69 at 10 years. There were 8 knees that had evidence of partial, progressive tibial radiolucencies at 10 years.
Porous tantalum TMCs demonstrated persistently durable longer-term survivorship with a low rate of implant removal. The rare implant removals for component loosening or instability were offset by those required for periprosthetic joint infection, which accounted for 80% of cone removals. Porous tantalum TMCs provide an extremely reliable tool to address tibial bone loss and achieve durable long-term fixation in revision TKA.
IV.
高度多孔金属胫骨干骺端锥体（TMC）常用于翻修全膝关节置换术（TKA），以解决骨量丢失和获得生物固定。中期（5 至 10 年）研究先前已经证明了极好的存活率和高骨整合率，但缺乏长期研究。我们旨在评估使用 TMC 进行翻修 TKA 后的长期（≥10 年）植入物存活率、并发症以及临床和影像学结果。
在 2004 年至 2011 年间，在一家机构进行了 228 例使用多孔钽 TMC 和带柄胫骨组件的翻修 TKA，回顾性分析了这些病例。翻修时的平均年龄为 65 岁，平均体重指数为 33，52%为女性。评估了植入物存活率、并发症以及临床和影像学结果。平均随访时间为 6.3 年。
10 年无无菌性松动导致 TMC 取出的存活率为 97%，无任何 TMC 取出的存活率为 88%，无任何再次翻修的存活率为 66%，无任何再次手术的存活率为 58%。再次翻修的最常见指征是假体周围关节感染、不稳定和无菌股骨组件松动。10 年非手术并发症发生率为 24%。Knee Society 评分从术前的 38 分增加到 10 年时的 69 分。10 年时，有 8 例出现胫骨部分、进行性透亮线的证据。
多孔钽 TMC 具有持久耐用的长期存活率，植入物取出率低。罕见的因组件松动或不稳定而取出的植入物，被因假体周围关节感染而需要取出的植入物所抵消，假体周围关节感染占锥体取出的 80%。多孔钽 TMC 为解决胫骨骨量丢失和实现翻修 TKA 的持久长期固定提供了一种极其可靠的工具。
IV。
