Revision total knee arthroplasty using a novel 3D printed titanium augment: A biomechanical cadaveric study

2020 ◽  
Vol 110 ◽  
pp. 103944
Author(s):  
C. Dion ◽  
G. Yamomo ◽  
J. Howard ◽  
M. Teeter ◽  
R. Willing ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Cadaveric Study ◽  
3D Printed ◽  
Total Knee

scholarly journals Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-customized Three-dimensional-printed Metaphyseal Cones in Revision Total Knee Arthroplasty

2020 ◽  
Author(s):  
Yang Li ◽  
Xinguang Wang ◽  
Hua Tian
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
3D Printed ◽  
Total Knee ◽  
The Mean ◽  
Highly Porous

Abstract Background: The reconstruction of massive bone defects is one of the main challenges in revision total knee arthroplasty (RTKA). Although several methods are available, each of them has its prominent shortcomings. The purpose of this study is to review the clinical outcomes of RTKA with massive proximal tibial bone defects using patient-customized three-dimensional (3D)-printed highly porous metaphyseal cones.Methods: We retrospectively reviewed seven RTKAs with Anderson Orthopaedic Research Institute (AORI) type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones, which have been performed at a single institution between 2016 and 2018. Results: The mean age at diagnosis of the patients was 68 years old (61-77). The mean length of follow-up was 25.3 months (19-36). At the latest follow-up, no aseptic loosening or prosthetic joint infection has been determined. The mean HSS increased from 49 (39-63) to 78 (70-83) (P<0.01); the mean WOMAC increased from 59 (46-73) to 26 (12-38) (P<0.01). All patients obtained the range of motion and mechanical alignment improvement postoperatively.Conclusion: The patient-customized 3D-printed metaphyseal cone could be a promising technique in addressing severe tibial defects in RTKA. Our study shows encouraging short-term clinical and radiological outcomes with no aseptic loosening, periprosthetic infection, or fracture. Nevertheless, further follow-up and the expansion of sample size are needed to demonstrate the advantage of this innovative technique fully.

Short-term Outcomes of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty

Orthopedics ◽  
2020 ◽  
Author(s):  
Ethan A. Remily ◽  
Iciar M. Dávila Castrodad ◽  
Nequesha S. Mohamed ◽  
Wayne A. Wilkie ◽  
Margaret N. Kelemen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Short Term ◽  
3D Printed ◽  
Total Knee

Excellent two-year survivorship of 3D-printed metaphyseal cones in revision total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 107-115 ◽  
Author(s):  
Matthew W. Tetreault ◽  
Kevin I. Perry ◽  
Mark W. Pagnano ◽  
Arlen D. Hanssen ◽  
Matthew P. Abdel
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Severe Bone Loss ◽  
Implant Survivorship ◽  
History Of ◽  
3D Printed ◽  
Total Knee ◽  
The Mean

Aims Metaphyseal fixation during revision total knee arthroplasty (TKA) is important, but potentially difficult when using historical designs of cone. Material and manufacturing innovations have improved the size and shape of the cones which are available, and simplified the required bone preparation. In a large series, we assessed the implant survivorship, radiological results, and clinical outcomes of new porous 3D-printed titanium metaphyseal cones featuring a reamer-based system. Methods We reviewed 142 revision TKAs in 139 patients using 202 cones (134 tibial, 68 femoral) which were undertaken between 2015 and 2016. A total of 60 involved tibial and femoral cones. Most cones (149 of 202; 74%) were used for Type 2B or 3 bone loss. The mean age of the patients was 66 years (44 to 88), and 76 (55 %) were female. The mean body mass index (BMI) was 34 kg/m2 (18 to 60). The patients had a mean of 2.4 (1 to 8) previous operations on the knee, and 68 (48%) had a history of prosthetic infection. The mean follow-up was 2.4 years (2 to 3.6). Results Survivorship free of cone revision for aseptic loosening was 100% and survivorship free of any cone revision was 98%. Survivorships free of any revision and any reoperation were 90% and 83%, respectively. Five cones were revised: three for infection, one for periprosthetic fracture, and one for aseptic tibial loosening. Radiologically, three unrevised femoral cones appeared loose in the presence of hinged implants, while the remaining cones appeared stable. All cases of cone loosening occurred in patients with Type 2B or 3 defects. The mean Knee Society score (KSS) improved significantly from 50 (0 to 94) preoperatively to 87 (72 to 94) (p < 0.001). Three intraoperative fractures with cone impaction (two femoral, one tibial) healed uneventfully. Conclusion Novel 3D-printed titanium cones, with a reamer-based system, yielded excellent early survivorship and few complications in patients with severe bone loss undergoing difficult revision TKA. The diversity of cone options, relative ease of preparation, and outcomes rivalling those of previous designs of cone support their continued use. Cite this article: Bone Joint J 2020;102-B(6 Supple A):107–115.

scholarly journals Reconstruction for massive proximal tibial bone defects using patient-customized three-dimensional-printed metaphyseal cones in revision total knee arthroplasty

2020 ◽  
Author(s):  
Yang Li ◽  
Xinguang Wang ◽  
Hua Tian
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
3D Printed ◽  
Total Knee ◽  
The Mean ◽  
Highly Porous

Abstract Background The reconstruction of massive bone defects is one of the main challenges in revision total knee arthroplasty (RTKA). Although several methods are available, each of them has its prominent shortcomings. The purpose of this study is to review the clinical outcomes of RTKA with massive proximal tibial bone defects using patient-customized three-dimensional (3D)-printed highly porous metaphyseal cones. Methods We retrospectively reviewed seven RTKAs with Anderson Orthopaedic Research Institute (AORI) type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones, which have been performed at a single institution between 2016 and 2018. The mean length of follow-up was 25.3 months (19–36). Results The mean age at diagnosis of the patients was 68 years old (61–77). At the latest follow-up, no aseptic loosening or prosthetic joint infection has been determined. The mean HSS increased from 49 (39–63) to 78 (70–83) (P < 0.01); the mean WOMAC increased from 59 (46–73) to 26 (12–38) (P < 0.01). All patients obtained the range of motion and mechanical alignment improvement postoperatively. Conclusion The patient-customized 3D-printed metaphyseal cone could be a promising technique in addressing severe tibial defects in RTKA. Our study shows encouraging short-term clinical and radiological outcomes with no aseptic loosening, periprosthetic infection, or fracture. Nevertheless, further follow-up and the expansion of sample size are needed to demonstrate the advantage of this innovative technique fully.

3D-printed titanium metaphyseal cones in revision total knee arthroplasty with cemented and cementless stems

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 150-157
Author(s):  
Lucas A. Anderson ◽  
Matthew Christie ◽  
Brenna E. Blackburn ◽  
Chad Mahan ◽  
Christian Earl ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Sagittal Plane ◽  
Revision Total Knee Arthroplasty ◽  
Logistic Regression Models ◽  
Metaphyseal Fixation ◽  
Increased Risk ◽  
Primary Tkas ◽  
3D Printed ◽  
Total Knee

Aims Porous metaphyseal cones can be used for fixation in revision total knee arthroplasty (rTKA) and complex TKAs. This metaphyseal fixation has led to some surgeons using shorter cemented stems instead of diaphyseal engaging cementless stems with a potential benefit of ease of obtaining proper alignment without being beholden to the diaphysis. The purpose of this study was to evaluate short term clinical and radiographic outcomes of a series of TKA cases performed using 3D-printed metaphyseal cones. Methods A retrospective review of 86 rTKAs and nine complex primary TKAs, with an average age of 63.2 years (SD 8.2) and BMI of 34.0 kg/m2 (SD 8.7), in which metaphyseal cones were used for both femoral and tibial fixation were compared for their knee alignment based on the type of stem used. Overall, 22 knees had cementless stems on both sides, 52 had cemented stems on both sides, and 15 had mixed stems. Postoperative long-standing radiographs were evaluated for coronal and sagittal plane alignment. Adjusted logistic regression models were run to assess malalignment hip-knee-ankle (HKA) alignment beyond ± 3° and sagittal alignment of the tibial and femoral components ± 3° by stem type. Results No patients had a revision of a cone due to aseptic loosening; however, two had revision surgery due to infection. In all, 26 (27%) patients had HKA malalignment; nine (9.5%) patients had sagittal plane malalignment, five (5.6%) of the tibia, and four (10.8%) of the femur. After adjusting for age, sex, and BMI, there was a significantly increased risk for malalignment when a cone was used and both the femur and tibia had cementless compared to cemented stems (odds ratio 3.19, 95% confidence interval 1.01 to 10.05). Conclusion Porous 3D-printed cones provide excellent metaphyseal fixation. However, these central cones make the use of offset couplers difficult and may generate malalignment with cementless stems. We found 3.19-times higher odds of malalignment in our TKAs performed with metaphyseal cones and both femoral and tibial cementless stems. Cite this article: Bone Joint J 2021;103-B(6 Supple A):150–157.

scholarly journals Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jake von Hintze ◽  
Mika Niemeläinen ◽  
Harri Sintonen ◽  
Jyrki Nieminen ◽  
Antti Eskelinen
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

Patellar Tracking in Revision Total Knee Arthroplasty: Does Retaining a Patella From a Different Implant System Matter?

2021 ◽  
Author(s):  
David Yeroushalmi ◽  
Stephen Zak ◽  
Mohamad Sharan ◽  
Jenna A. Bernstein ◽  
Ran Schwarzkopf ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Patellar Tracking ◽  
Total Knee ◽  
Implant System

Revision Total Knee Arthroplasty

2007 ◽  
Vol 464 ◽  
pp. 146-150 ◽  
Author(s):  
Robert L Barrack ◽  
J Thomas McClure ◽  
Corey F Burak ◽  
John C Clohisy ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Total Knee
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