Promising short-term outcomes of free-hand burring technique to implant second-generation metaphyseal cone in Asian knees—a case series

Abstract

<p>Introduction: The second-generation metaphyseal cone has been proven effective in managing bone defect in revision knee arthroplasty in the Caucasian literature. We report our surgical techniques and short-term outcomes in Asian knees.<br>Methods: We conducted a case series by consecutively recruiting 14 female and 12 male patients with a mean age of 71 years (range 54-88 years) with 26 knees, who underwent revision total knee arthroplasty during the period April 2017 to June 2022. 24 tibial cones and 4 femoral cones were used. The mean follow-up duration was 47 months (range 12-74 months). Due to the relatively small bone size and meta-diaphyseal center mismatch in the Asian knees, the free-hand burring technique instead of the cannulated reaming technique was adopted in preparing for cone implantation. The clinical outcomes were knee ranges of motion (ROM), the Knee Society Knee scores (KSS), end-of-stem pain, infection, and need for revision surgery. The radiological outcomes were osteointegration, fracture, and loosening.<br>Results: Mean knee range of motion improved from 84 degrees (range, 0-120) preoperatively to 107 degrees (range, 60-125) postoperatively (p<0.001). Mean KSS scores improved significantly from 28 (range, 0-70) to 67 (range, 5-100) [p<0.001]. All cones were osteointegrated. There were one case with transient end-of-stem pain, two intraoperative minor femoral fractures and one recurrent infection that did not require cone revision. Cone revision-free survivorship was 100%. There was no aseptic loosening.<br>Discussion and Conclusion: The second-generation cone with free-hand burring technique yielded promising short-term outcomes in Asian knees.</p>