Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

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Abstract

The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.

Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.

Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.

Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

About the authors

A. A. Cherny

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: alexander.cherny.spb@gmail.com

Alexander A. Cherny — orthopaedic surgeon

St. Petersburg

Russian Federation

A. N. Kovalenko

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Anton N. Kovalenko — cand. Sci. (Med.), researcher, Department of Diagnosis of Diseases and Injuries of the Musculoskeletal System

St. Petersburg

Russian Federation

S. S. Bilyk

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Stanislav S. Bilyk — laboratory assistant-researcher, Department of Diagnosis of Diseases and Injuries of the Musculoskeletal System

St. Petersburg

Russian Federation

A. O. Denisov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Aleksey O. Denisov — cand. Sci. (Med.), academic secretary

St. Petersburg

Russian Federation

A. V. Kazemirskiy

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Alexander V. Kazemirskiy — cand. Sci. (Med.), senior researcher, Knee Pathology Department

St. Petersburg

Russian Federation

T. A. Kulyaba

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Taras A. Kulyaba — Dr. Sci. (Med.), head of the Knee Pathology Department

St. Petersburg

Russian Federation

N. N. Kornilov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Nikolai N. Kornilov — Dr. Sci. (Med.), professor, chair of Traumatology and orthopedics; leading researcher, Knee Pathology Department

St. Petersburg

Russian Federation

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  1. Rajgopal A, Kumar S, Aggarwal K. Midterm Outcomes of Tantalum Metal Cones for Severe Bone Loss in Complex Primary and Revision Total Knee Arthroplasty. Arthroplasty Today. 2021;7:76. doi: 10.1016/j.artd.2020.12.004
  2. Cavagnaro L, Chiarlone F, Mosconi L, Sermi N, Felli L, Burastero G. Custom-made endofemoral sleeves in knee revision surgery: case report and technical notes. Lo Scalpello - Otodi Educational. 2021;35(2):96. doi: 10.36149/0390-5276-193
  3. Burastero G, Pianigiani S, Zanvettor C, Cavagnaro L, Chiarlone F, Innocenti B. Use of porous custom-made cones for meta-diaphyseal bone defects reconstruction in knee revision surgery: a clinical and biomechanical analysis. Archives of Orthopaedic and Trauma Surgery. 2020;140(12):2041. doi: 10.1007/s00402-020-03670-6
  4. Konashuk AS, Brykalova XO, Kornilov NN, Filatova EO, Pavlychev AA. Hierarchy-induced X-ray linear dichroism in cortical bone. Emergent Materials. 2020;3(4):515. doi: 10.1007/s42247-020-00105-1
  5. Rukin YA, Lychagin AV, Murylev VY, Garkavi AV, Tarasov DA, Elizarov MP. Hip Arthroplasty in Patients with Hip Dysplasia by Individual Augments: Early Results. Traumatology and Orthopedics of Russia. 2020;26(2):50. doi: 10.21823/2311-2905-2020-26-2-50-59

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