Total knee surgery: our experience

Viktor Kamnar, Anastasika Poposka, Milena Bogojevska Doksevska


Introduction: Revision knee arthroplasty is not a routine procedure and almost always it is a technically demanding operation. The paradigm in revision total knee arthroplasty is to achieve correct alignment of the components, maintenance of the joint space and ligament balance by providing a stable bone – implant fusion. Metaphyseal bone loss is a crucial problem in revision total knee arthroplasty. The bone loss is due to primary arthroplasty technical errors and design, or problematic removal of the implants.

Aim: The aim of this article is to present our experience on total knee revision surgery using tantalum metal cones as a structural bone graft substitute in total arthroplasty failure with gross metaphyseal bone loss categorized by the AORI classification, performed by a specific surgical technique and evaluated by the Knee Society Score (KSS).

Material and methods: From 2013 to 2016 at the University Clinic for Orthopedic Surgery in Skopje 21 patient has been treated with revision total knee arthroplasty. Twelve patients had type 1/type 2 bone defects according to AORI, and nine had type 3 bone defect. We used trabecular metal bone graft in type 3 bone defects. A special emphasis is placed on preoperative planning according to the classification system for ligament and soft tissue damage as well as the AORI classification in order to determine the quantity, location and extent of the bone loss. In our series in patients with type 3 deformities, trabecular metal augments were used. This material resembles the human trabecular bone by its cellular structure and elastic characteristics.

Results: Preoperatively, all the patients had Knee Society Score below 60, most of them were housebound, experiencing great pain and disability. After six months 95% were rated excellent, and on one year follow up, 89% were rated good or excellent (KSS score above 82, mean score 81.5), 1 patient was marked as poor with a complication – dislocation of the prosthesis. In the follow up period there was no infection.

Conclusion: Our results of revision knee arthroplasty by using the trabecular metal augments with at least a year of follow up are excellent according to the KSS compared to the other studies. The disadvantages of the study are mentioned and the need for further investigation is stressed.


Revision knee arthroplasty, metaphyseal bone loss, AORI classification, Knee Society scores, trabecular metal augments

Full Text:



Mozella Ade P, Olivero RR, Alexandre H, Cobra AB. Use of a trabecular metal cone made of tantalum, to treat bone defects during revision knee arthroplasty. Rev Bras Ortop. 2014;49(3):245-51.

Lachiewicz PF, Watters TS. Porous metal metaphyseal cones for severe bone loss: when only metal will do. Bone Joint J. 2014;96-B(11 Supple A):118-21.

De Martino I, De Santis V, Sculco PK, D’Apolito R, Assini JB, Gasparini G. Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res. 2015;473(10):3176-82.

Schildhauer TA, Robie B, Muhr G, Koller M. Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials. J Orthop Trauma.2006; 20(7): 476-84.

Schildhauer TA, Peter E, Muhr G, Koller M. Activation of human leukocytes on tantalum trabecular metal in comparison to commonly used orthopedic metal implant materials. J Biomed Mater Res Part A. 2009; 88(2): 332-41.

W. Norman Scott, Insall and Scott Surgery of the Knee. 5th Ed. Churchill Livingstone, 2011.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13-4.

Bertin KC, Freeman MA, Samuelson KM, Ratcliffe SS, Todd RC. Stemmed revision arthroplasty for aseptic loosening of total knee replacement. J Bone Joint Surg Br. 1985;67(2):242-8.

Peters CL, Erickson JA, Gililland JM. Clinical and radiographic results of 184 consecutive revision total knee arthroplasties placed with modular cementless stems. J Arthroplasty. 2009;24(6 Suppl):48-53.

Radnay CS, Scuderi GR. Management of bone loss: augments, cones, offset stems. Clin Orthop Relat Res. 2006;446:83-92.

Qiu YY, Yan CH, Chiu KY, Ng FY. Review article: Treatments for bone loss in revision total knee arthroplasty. J OrthopSurg (Hong Kong). 2012;20(1):78-86.

Fosco M, Ayad RB, Amendola L, Dallari D, Tigani D. Management of bone loss in primary and revision knee replacement surgery. In Recent Advances in Arthroplasty 2012. InTech.

Bauman RD, Lewallen DG, Hanssen AD. Limitations of structural allograft in revision total knee arthroplasty. Clin Orthop Relat Res. 2009;467(3):818-24.

Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone JointSurg Am. 2007;89(8):1735–41.

Hockman DE, Ammeen D, Engh GA. Augments and allografts inrevision total knee arthroplasty: usage and outcome using onemodular revision prosthesis. J Arthroplasty. 2005;20(1):35–41.

Derome P, Sternheim A, Backstein D, Malo M.Treatment of large bone defects with trabecular metal cones in revision total knee arthroplasty: short term clinical and radiographic outcomes. J Arthroplasty. 2104;29 ( 1):122 – 6.

Long WJ, Scuderi GR. Porous tantalum cones for large metaphyseal tibial defects in revision total knee arthroplasty: a minimum 2 years follow up.J Arthroplasty. 2009:24(7): 1086 –92.

Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am. 2008;90(1):78-84.

De Martino I, De Santis V, Sculco PK, D'Apolito R, Assini JB, Gasparini G. Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res. 2015;473(10):3176-82.

Howard JL, Kudera J, Lewallen DG, Hanssen AD. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg Am. 2011;93(5):478-84.



  • There are currently no refbacks.

Copyright (c) 2017 Viktor Kamnar, Milena Bogojevska Doksevska, Anastasika Poposka

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.