Contemporary Outcomes of Highly Porous Metaphyseal Cones in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Graham S Goh, Seungjun Lee, Kevin Singh et al.
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In 30 seconds
This systematic review and meta-analysis assessed clinical and radiographic outcomes of highly porous metaphyseal cones in revision total knee arthroplasty (RTKA), drawing on 63 studies of 4,433 patients and 5,435 cones. Most reported bone defects were severe. At a weighted mean follow-up of 49.7 months, pooled all-cause re-revision was 13.5% (95% CI, 11.0 to 16.2), while cone removal was 3.6% (95% CI, 2.2 to 5.2). Radiographic osseointegration was 96.0% (95% CI, 92.5 to 98.5); outcomes did not differ significantly by cone material or fixation strategy.
Key findings
- Pooled radiographic osseointegration was 96.0% (95% CI, 92.5 to 98.5).
- All-cause re-revision was 13.5% (95% CI, 11.0 to 16.2) at a weighted mean follow-up of 49.7 months.
- Cone removal occurred in 3.6% (95% CI, 2.2 to 5.2); aseptic loosening accounted for 0.7%.
- Survivorship did not differ significantly between tantalum and titanium cones or between cemented and hybrid fixation.
Why it matters
Metaphyseal cones are used to address substantial bone loss in RTKA. This synthesis indicates high radiographic osseointegration and a low pooled rate of cone removal across contemporary studies, while identifying infection as the predominant cause of cone revision. The findings provide a broad summary of reported outcomes across cone materials and fixation approaches, although they do not establish comparative superiority.
What to keep in mind
The review pooled randomized and observational studies, and the abstract reports a weighted mean follow-up of 49.7 months; longer-term outcomes are not established here.