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J Knee Surg
DOI: 10.1055/a-2315-7778
Original Article

Short-term Comparison of Survivorship and Functional Outcomes for Metaphyseal Cones with Short and Long Stems in Revision Total Knee Arthroplasty

Nicolas S. Piuzzi 
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Emily L. Hampp
2   Division of Joint Replacement, Stryker Orthopaedics, Mahwah, New Jersey
,
Sarah Shi
2   Division of Joint Replacement, Stryker Orthopaedics, Mahwah, New Jersey
,
Manoshi Bhowmik-Stoker
2   Division of Joint Replacement, Stryker Orthopaedics, Mahwah, New Jersey
,
Nickelas Huffman 
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Kevin M. Denehy
3   Bluegrass Orthopaedics, Lexington, Kentucky
,
David C. Markel
4   The CORE Institute, Novi, Michigan
,
Daniel D. Li
5   Department of Orthopaedics, The Ohio State University, Columbus, Ohio
,
Michael A. Mont
6   Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Abstract

Printed porous titanium metaphyseal cones have become a mainstay for managing bone loss in revision total knee arthroplasty (rTKA). A short or long stem is routinely used when implanting a cone to augment fixation and offload stresses. This retrospective analysis compared the short-term survivorships and functional outcomes for use of a short or long stem with a metaphyseal cone.

A total of 179 cases using metaphyseal cones and stems with median follow-up of 1.95 years (interquartile range, 1.00–2.14) were compared based on stem type. There were 55 cases with long stem(s) and 124 cases with short stem(s). Cases with both long and short stems were excluded. Demographics, Kaplan–Meier survivorships, and preoperative and 1-year postoperative patient-reported outcome measures (PROMs; 2011 Knee Society Score [KSS] objective knee score, function, and satisfaction scores; EuroQol five-dimension scale; and Short Form Survey Physical Component Summary and Mental Component Summary scores) were compared using t-tests with a significance level of α = 0.05. There were no significant differences in body mass index (mean ± standard deviation) or sex (men [%]) between the short and long stem cohorts (32.3 ± 5.3, 36.3% and 31.5 ± 5.5, 38.2%, respectively; p > 0.05). Patients who had short stems were younger (65.9 ± 8.8 vs. 69.0 ± 9.4, p = 0.0323).

Revision-free survivorship for the femoral or tibial component was 100% for long stems and 98.2% for short stems at 1 and 2 years, respectively (log-rank p = 0.6330). The two revisions in the short group were for infection, thus the survivorship for aseptic loosening was 100% at 2 years for both cohorts. There were no significant differences in preoperative or postoperative PROMs.

This study demonstrated that highly porous printed metaphyseal cones provided rTKA with excellent early survivorship and similar PROMs whether a short or long stem was used. Additional studies will be needed to discern longer term differences.

Keywords

total knee arthroplasty - revision total knee arthroplasty - aseptic loosening - metaphyseal cones - stems


Publication History

Received: 20 December 2023

Accepted: 23 April 2024

Accepted Manuscript online:
27 April 2024

Article published online:
13 May 2024

© 2024. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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