Clinical and Radiological Evaluation of the Tantalum Cone Stacking Technique in the Treatment of Large Bone Defects in Revision Total Knee Arthroplasty
J.V.B. Mello, R.E. De Paula, A.D.P. Mozella, H.A.D.A.B. Cobra, D.M.D.B.D.R. BarrosObjectives:
To evaluate the clinical and radiological outcomes, as well as implant survivorship, in patients undergoing revision total knee arthroplasty (rTKA) with major bone defects treated using the stacked trabecular metal tantalum cone technique, in a tertiary center.
Methods:
A retrospective observational study conducted between 2017 and 2025. Twelve patients who underwent rTKA with AORI type 2 or 3 bone defects treated with stacked tantalum cones were included. Epidemiological data, cause of primary failure (septic/aseptic), number of prior surgeries, location of the stacked cones (femoral, tibial, or both), complications, and reoperation rates were collected. Osseointegration was assessed radiographically. Implant survivorship was defined as the absence of revision surgery.
Results:
The mean patient age was 73.25 years (±6.94), with 7 women and 5 men. The primary reason for revision was predominantly septic (9/12 cases). The mean number of prior knee surgeries was 4. The mean postoperative follow-up was 3 years. Overall implant survivorship was 75% (9/12 patients). Three patients required major reintervention: one underwent re-revision with an antibiotic spacer for recurrent infection, and two underwent amputations. No cases of radiographic aseptic loosening of the cones were observed.
Conclusion:
The stacked tantalum cone technique for major bone defects in complex rTKA proved to be a viable option, with an implant survivorship of 75% at initial follow-up. This technique represents a relevant alternative in high-complexity scenarios, often associated with prior infection and multiple surgeries. Studies with larger sample sizes and longer follow-up are required to confirm its long-term durability.