Short-term comparison of survivorship and functional outcomes for metaphyseal cones with short and long stems in revision total knee arthroplasty

Nicolas S Piuzzi; Emily Hampp; Sarah Shi; Manoshi Bhowmik-Stoker; Nickelas Huffman; Kevin Denehy; David Markel; Daniel D Li; Michael A Mont

doi:10.1055/a-2315-7778

Short-term comparison of survivorship and functional outcomes for metaphyseal cones with short and long stems in revision total knee arthroplasty

J Knee Surg. 2024 Apr 27. doi: 10.1055/a-2315-7778. Online ahead of print.

Authors

Nicolas S Piuzzi^{1

2}, Emily Hampp³, Sarah Shi⁴, Manoshi Bhowmik-Stoker⁵, Nickelas Huffman¹, Kevin Denehy⁶, David Markel⁷, Daniel D Li⁸, Michael A Mont⁹

Affiliations

¹ Orthopedics, Cleveland Clinic, Cleveland, United States.
² Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³ Implant and Robotic Research, Stryker, Mahwah, United States.
⁴ Research and Product Assurance, Stryker, Mahwah, United States.
⁵ Orthopaedics, Stryker, Mahwah, United States.
⁶ Orthopaedic surgery, University of Louisville, Louisville, United States.
⁷ Orthopedic Surgery, Providence-Providence Park Hospital, Novi, United States.
⁸ Orthopaedics, The Ohio State University, Columbus, United States.
⁹ Orthopaedic Surgery, Rubin Institute for Advanced Orthopedics, Baltimore, United States.

PMID: 38677298
DOI: 10.1055/a-2315-7778

Abstract

Introduction: Printed porous titanium metaphyseal cones have become a mainstay for managing bone loss in revision total knee arthroplasty (rTKA). A short or long stem is routinely used when implanting a cone to augment fixation and offload stresses. This retrospective analysis compared the short-term survivorships and functional outcomes for use of a short or long stem with a metaphyseal cone.

Methods: A total of 179 cases using metaphyseal cones and stems with median follow-up of 1.95 years (Interquartile range, 1.00 to 2.14) were compared based on stem type. There were 55 cases with long stem(s) and 124 cases with short stem(s). Cases with both long and short stems were excluded. Demographics, Kaplan-Meier survivorships, and preoperative and one-year postoperative patient reported outcome measures (PROMs) [2011 Knee Society Score (KSS) objective knee score, function, and satisfaction scores; EuroQol five-dimension scale (EQ5D); and Short Form Survey (SF12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores] were compared using t-tests with a significance level of α=0.05. There were no significant differences in body mass index (BMI) (mean ± SD) or sex [men (%)] between the short stem and long stem cohorts (32.3 ± 5.3, 36.3% and 31.5 ± 5.5, 38.2%, respectively; P >0.05). Patients who had short stems were younger (65.9 ± 8.8 vs. 69.0 ± 9.4, P=0.0323).

Results: Revision-free survivorship for the femoral or tibial component was 100% for long stems and 98.2% for short stems at one- and two-years, respectively (log-Rank P=0.6330). The two revisions in the short group were for infection, thus the survivorship for aseptic loosening was 100% at two years for both cohorts. There were no significant differences in preoperative or postoperative PROMs.

Conclusion: This study demonstrated that highly porous printed metaphyseal cones provided rTKA with excellent early survivorship and similar PROMs whether a short or long stem was used. Additional studies will be needed to discern longer-term differences.

Publication types

Clinical Trial