Villa Jesus M, Mashni Sam J, Bains Sandeep S, Singh Vivek, Redden Anna R, Malkani Arthur L, Delanois Ronald E, Higuera Carlos A
Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.
Department of Orthopedic Surgery, University of Louisville, Adult Reconstruction Program, Louisville, Kentucky.
J Arthroplasty. 2025 Sep;40(9S1):S363-S367. doi: 10.1016/j.arth.2025.04.015. Epub 2025 Apr 9.
The survivorship of tibial metaphyseal cones following revision total knee arthroplasty (rTKA) has been reported. However, literature comparing cone midterm survivorship (from five to 10 years after rTKA) between septic (infection history on the joint) and aseptic revisions is scarce. Therefore, we sought: (1) to assess the overall tibial cone survivorship rate after rTKA; and (2) to compare cone survivorship between septic and aseptic revisions.
A multicenter retrospective chart review of 231 patients who underwent rTKA using highly porous titanium tibial metaphyseal cones (June 15, 2015 to May 4, 2018) was conducted. A total of 80 patients were excluded, leaving 151 rTKA patients (40 septic and 111 aseptic knees) for analyses. Demographics and surgical characteristics were noted. The mean age and body mass index of patients were 64 years and 34.6, respectively. Survivorship rates of rTKA and tibial cones were established. The mean follow-up of surviving cones was six years (range, five to eight).
Of 151 patients included, 30 (19.9%) underwent a subsequent total knee arthroplasty revision. At the latest follow-up, according to the Knee Society grading system, 115 (95.0%) of surviving rTKAs were deemed stable, three (2.5%) warranted close observation, and three (2.5%) were loose. Only 14 (9.3%) tibial cones were ultimately extracted. Thus, the overall cone survivorship rate was 90.7% with no significant differences between survivorship rates of cones implanted during either septic (87.5%) or aseptic (91.9%) rTKAs (P = 0.52).
The survivorship of tibial metaphyseal cones was good at a minimum follow-up of five years with no significant differences in survivorship between septic and aseptic rTKAs. Our data support the use of highly porous titanium tibial cones to improve metaphyseal fixation during rTKA even when there is a history of a knee infection.
已有关于翻修全膝关节置换术（rTKA）后胫骨干骺端锥体生存率的报道。然而，比较感染性（关节有感染史）和无菌性翻修之间锥体中期生存率（rTKA后5至10年）的文献较少。因此，我们旨在：（1）评估rTKA后胫骨锥体的总体生存率；（2）比较感染性和无菌性翻修之间的锥体生存率。
对231例行rTKA并使用高度多孔钛质胫骨干骺端锥体的患者（2015年6月15日至2018年5月4日）进行多中心回顾性病历审查。共排除80例患者，剩余151例rTKA患者（40例感染性膝关节和111例无菌性膝关节）用于分析。记录人口统计学和手术特征。患者的平均年龄和体重指数分别为64岁和34.6。确定rTKA和胫骨锥体的生存率。存活锥体的平均随访时间为6年（范围为5至8年）。
在纳入的151例患者中，30例（19.9%）接受了后续的全膝关节置换术翻修。在最近一次随访时，根据膝关节协会评分系统，115例（95.0%）存活的rTKA被认为稳定，3例（2.5%）需要密切观察，3例（2.5%）松动。最终仅取出14个（9.3%）胫骨锥体。因此，锥体总体生存率为90.7%，感染性rTKA（87.5%）或无菌性rTKA（91.9%）期间植入的锥体生存率之间无显著差异（P = 0.52）。
胫骨干骺端锥体在至少5年的随访中生存率良好，感染性和无菌性rTKA之间的生存率无显著差异。我们的数据支持使用高度多孔钛质胫骨锥体来改善rTKA期间的干骺端固定，即使存在膝关节感染史。
