Abstract
Introduction
Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. However, there are few studies evaluating outcomes out to five years with a sufficient cohort. The purpose of this study was to evaluate implant survivorship and complications in revision TKAs with tibial cones.
Methods
A retrospective review was completed from September 2006 through March 2018 evaluating 149 revision TKAs that received a tibial cone. The mean follow-up was 5.3 years. According to the AORI classification: 8% were 1, 18% were 2A, 55% were 2B, and 19% were 3.
Results
Survival analysis at 6 years showed 96% free of revision for aseptic tibial loosening, 85% free of tibial component revision for any reason, and 72% free of reoperation. Eleven knees had progressive radiolucent lines with eight having tibial construct migration on serial radiographs. Aseptic tibial loosening was associated with significant tibial bone loss, AORI 3 (p=0.0001). Tibial component revision for any reason was associated with AORI 3 (p=0.013) and a pre-revision diagnosis of reimplantation after PJI (p<0.0001). Four knees had revision for aseptic tibial loosening, 12 knees had revision of the tibial construct for reasons other than aseptic loosening (11/12 were for PJI), and 15 knees had reoperation for reasons other than tibial construct revision.
Conclusions
Revision TKA with tibial cones had excellent survivorship free of revision for tibial construct aseptic loosening, 96% at 6 years. Patients receiving a tibial cone construct at the time of reimplantation for PJI were at increased risk for tibial construct revision.
