Pumford Andrew D, Wright Breydan H, Bedard Nicholas A, Wyles Cody C, Abdel Matthew P, Hannon Charles P
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2025 Sep;40(9S1):S368-S375. doi: 10.1016/j.arth.2025.04.059. Epub 2025 May 6.
Metaphyseal cones can be used to address bone loss and/or obtain reliable biologic fixation in revision total knee arthroplasties (TKAs). Sometimes, larger bone defects mandate using more than one cone on either the femoral or tibial side. This study aimed to evaluate implant survivorship, radiographic results, and clinical outcomes of revision TKAs with multiple stacked cones.
We identified 50 revision TKAs using stacked cones performed at a single academic institution from 2011 to 2021. Stacked cones were used in the tibia in 26 patients (52%), femur in 22 patients (44%), and both in two patients (4%). The mean age was 69 years, the mean body mass index was 33, and 74% were men. Kaplan-Meier survivorship curves were calculated, radiographs were reviewed, and clinical outcomes were evaluated with Knee Society Function Score. The mean follow-up was 5 years (range, 17 days to 10 years).
The 5-year survivorship free of rerevision for aseptic loosening of the stacked cone constructs was 93%, and free of any stacked cone rerevision was 75%. There were nine stacked cone constructs (six femoral and three tibial) rerevised, with periprosthetic joint infection (PJI; n = 7; 3 with prior PJI) and aseptic loosening (n = 2) being the indications for rerevision. The 5-year survivorship free of any rerevision and any reoperation was 58 and 50%, respectively. There were 17 rerevisions, with aseptic loosening (n = 8) and PJI (n = 8) being the most common reasons. There were two nonrerevised stacked cone constructs that had signs of radiographic loosening. The mean Knee Society Score was 54.
Stacked cones demonstrated modest survivorship at a mean 5-year follow-up with a low rate of aseptic loosening. However, 50% of these cases required a reoperation, highlighting this complex cohort and selection bias to those receiving stacked cones.
干骺端椎体可用于解决全膝关节置换翻修术（TKA）中的骨质缺损和/或获得可靠的生物固定。有时，较大的骨缺损需要在股骨或胫骨侧使用多个椎体。本研究旨在评估使用多个堆叠椎体的TKA翻修术的植入物生存率、影像学结果和临床结局。
我们确定了2011年至2021年在单一学术机构进行的50例使用堆叠椎体的TKA翻修术。26例患者（52%）在胫骨中使用了堆叠椎体，22例患者（44%）在股骨中使用，2例患者（4%）在双侧使用。平均年龄为69岁，平均体重指数为33，74%为男性。计算Kaplan-Meier生存率曲线，复查X线片，并使用膝关节协会功能评分评估临床结局。平均随访时间为5年（范围为17天至10年）。
堆叠椎体结构无菌性松动无需再次翻修的5年生存率为93%，无需任何堆叠椎体再次翻修的生存率为75%。有9个堆叠椎体结构（6个股骨和3个胫骨）进行了再次翻修，假体周围关节感染（PJI；n = 7；3例既往有PJI）和无菌性松动（n = 2）是再次翻修的指征。无任何再次翻修和任何再次手术的5年生存率分别为58%和50%。有17例再次翻修，无菌性松动（n = 8）和PJI（n = 8）是最常见的原因。有2个未再次翻修的堆叠椎体结构有影像学松动的迹象。膝关节协会平均评分为54分。
在平均5年的随访中，堆叠椎体显示出适度的生存率，无菌性松动率较低。然而，这些病例中有50%需要再次手术，突出了这一复杂队列以及接受堆叠椎体患者的选择偏倚。
