Abstract
Total knee arthroplasty in the setting of osseous defects has multiple management options. However, the optimal treatment strategy remains controversial. The purpose of this study is to report the clinical and radiographic results of trabecular metal cones in managing osseous defects in the setting of complex primary and revision total knee arthroplasty.
There were 129 consecutive total knee arthroplasty procedures performed utilising trabecular metal cones reviewed for clinical and radiographic outcomes. Twenty-five had less than 2 years of follow-up and seven died, leaving 96 patients for evaluation. This cohort included a total of eighty-six (86) tibias with eleven (11) having Type 1 defects, twenty-five (25) having Type 2A defects, forty-three (43) with Type 2B defects and seven (7) with Type 3 defects. There were twenty-seven (27) femurs with one (1) Type 1 defect, nine (9) Type 2A defects, sixteen (16) with Type 2B defects and one (1) Type 3 defect based on the AORI classification. There were 28 male patients and 68 female patients, with an average age of 68 years and an average BMI of 35.0. There were six primary procedures and ninety revision procedures. Continuous variables were evaluated using a t-test.
Twelve patients required revision leaving 84 knees (87.5%) with the cones in place at an average of 31 months of follow-up (range, 24–77.3 months). The mean KSS score increased from 51.0 preoperatively to 80.2 postoperatively (p<0.0001). The mean KSS functional score increased from 32.9 preoperatively to 47.8 postoperatively (p=0.0002). Including the twelve revisions, there were twenty-two knees requiring re-operation (22.9%) with another seventeen requiring manipulation under anesthesia and there were four additional non-operative complications (1 foot drop, 1 stress fracture, 2 superficial infections).
