Metaphyseal cones with cemented stems are frequently used in revision total knee arthroplasty (TKA). However, if the diaphysis has been previously violated, the resultant sclerotic canal can impair cemented stem fixation, which is vital for bone ingrowth into the cone, and long-term fixation. We report the outcomes of our solution to this problem, in which impaction grafting and a cemented stem in the diaphysis is combined with an uncemented metaphyseal cone, for revision TKA in patients with severely compromised bone. A metaphyseal cone was combined with diaphyseal impaction grafting and cemented stems for 35 revision TKAs. There were two patients with follow-up of less than two years who were excluded, leaving 33 procedures in 32 patients in the study. The mean age of the patients at the time of revision TKA was 67 years (32 to 87); 20 (60%) were male. Patients had undergone a mean of four (1 to 13) previous knee arthroplasty procedures. The indications for revision were aseptic loosening (80%) and two-stage reimplantation for prosthetic joint infection (PJI; 20%). The mean follow-up was four years (2 to 11).Aims
Methods
Metaphyseal cones with cemented stems are frequently used in revision total knee arthroplasties (TKAs). However, if the diaphysis has been previously violated (as in revision of a failed stemmed implant), the resultant sclerotic canal can impair cemented stem fixation, which is vital for cone ingrowth and long-term fixation. We report the outcomes of our novel solution to this problem, in which impaction grafting and a cemented stem in the diaphysis was combined with an uncemented metaphyseal cone for revision TKAs with severely compromised bone. A metaphyseal cone was combined with diaphyseal impaction grafting and cemented stems in a novel fashion for 35 revision TKAs. Mean age at revision TKA was 70 years, with 63% being male. Patients had a mean of 4 prior knee arthroplasty procedures. Indications for the revision with this construct were aseptic loosening (80%) and two-stage re-implantation for periprosthetic infection (PJI; 20%). Mean follow-up was 3 years.Introduction
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