Can tibial tantalum cones eventually eliminate the adjuvant use of metallic augments for AORI type 2B/3 metaphyseal defects??—A novel surgical technique and case series

Mohit M Kukreja,Todd V Swanson

doi:10.1016/j.ijscr.2018.09.028

Mohit M Kukreja, Todd V Swanson

Open Access

https://doi.org/10.1016/j.ijscr.2018.09.028

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Abstract

BackgroundFor extensive metaphyseal defects, the use of tantalum cones is usually combined with adjuvant stems which may be cemented/cementless and metallic bone augments for additional stability. A Tibial baseplate-Cone construct with proud tibial cones and without metallic augments has been described for AORI type 2B/3 tibial defects. MethodsA case series analysis of 6 patients with AORI type 3 defects treated with unstepped proud Tantalum tibial metaphyseal cones without metallic wedges/full width augments. A follow-up analysis done with clinico-radiographic interpretation. Results100% osteointegration noted in final radiographs of all patients at an average follow-up of 4.1 years. Preoperative average ROM/KSS of 75/49 improved to postoperative ROM/KSS of 104/79. Outcomes were interpreted as excellent in 50% of cases and good in the remaining 50%. ConclusionThe “Tibial base plate-cone without augments (BCCA)”type of a construct may offer a valid long term advantage over the Tibial base plate-Augment-Cone combination in massive tibial bone defects. Simply building up the tantalum cone to the native joint line position by increasing cone height can exclude use of augments or wedges.

Highlights

Massive bone defects presenting concomitantly with component loosening, subsidence and osteolysis are a routine intraoperative finding during Revision TKA
The bone defect may result from the design of the primary prosthesis used, the actual initial disease process, the technical errors done during the index operation or iatrogenically while removing the prosthesis [1].Axial and rotational stability of implanted components are both highly compromised in the presence of large metaphyseal and metaphyseo-diaphyseal bone defects
The Tibial Baseplate-Cone Construct without Augments(BCCA) [We would like to advocate this terminology for such a construct where one can deliberately eliminate the use of augments by using a thicker cone and building up the joint surface to the nearest possible anatomical position] was used in 6 patients with AORI type-3 massive tibial metaphyseal bone loss encountered in Revision TKA

Summary

Introduction

Massive bone defects presenting concomitantly with component loosening, subsidence and osteolysis are a routine intraoperative finding during Revision TKA. The use of tantalum cones is usually combined with adjuvant stems which may be cemented/cementless and metallic bone augments for additional stability. A Tibial baseplate-Cone construct with proud tibial cones and without metallic augments has been described for AORI type 2B/3 tibial defects. METHODS: A case series analysis of 6 patients with AORI type 3 defects treated with unstepped proud Tantalum tibial metaphyseal cones without metallic wedges/full width augments. RESULTS: 100% osteointegration noted in final radiographs of all patients at an average follow-up of 4.1 years. CONCLUSION: The “Tibial base plate-cone without augments (BCCA)”type of a construct may offer a valid long term advantage over the Tibial base plate-Augment-Cone combination in massive tibial bone defects. Building up the tantalum cone to the native joint line position by increasing cone height can exclude use of augments or wedges

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