Do Porous Tantalum Metaphyseal Cones Improve Outcomes in Revision Total Knee Arthroplasty?

Daniel D. Bohl, Nicholas Brown, Mitchell A. McDowell, Brett R. Levine, Scott M. Sporer, Wayne G. Paprosky, Craig J. Della Valle

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13 Citations (Scopus)


Background Some authors have advocated for use of porous tantalum metaphyseal cones to manage bone defects during revision total knee arthroplasty (TKA). The purpose of this study is to compare results with porous metaphyseal cones to results with traditional hybrid stem fixation in revision TKA. Methods Forty-nine patients undergoing revision TKA with femoral and/or tibial metaphyseal cones (39 tibial only, 3 femoral only, 7 both) were matched by surgical indication to 49 patients undergoing revision TKA with a traditional hybrid stem (non-cone) technique. Clinical and radiographic outcomes were compared at a minimum of two-year follow-up (mean 3.5 years) with adjustment for baseline characteristics. Results Pre-revision bone defects and most baseline demographics were similar between the cone and non-cone cohorts suggesting appropriate matching. Patients in the non-cone cohort had greater pre- to post-operative increases in Knee Society Score (37.2 ± 18.6 vs 28.4 ± 17.8, P =.010) and Knee Society Functional Score (30.4 ± 24.3 vs 13.1 ± 27.6, P =.003). The cohorts did not differ with respect to complications, subsequent reoperation, subsequent revision, patient satisfaction, tibial overhang, the presence of radio-sclerotic lines, cortical hypertrophy around the stems, or tibial subsidence. Conclusion In this series, metaphyseal cones were not associated with superior outcomes at short-term follow-up. Given the increased cost associated with use of cones compared to traditional techniques, this study cannot support the routine use of metaphyseal cones in revision TKA. Longer-term follow-up will be necessary to determine if construct durability differs over the long term.

Original languageEnglish
Pages (from-to)171-177
Number of pages7
JournalJournal of Arthroplasty
Issue number1
Publication statusPublished - Jan 2018
Externally publishedYes


  • metaphyseal cones
  • metaphyseal defects
  • revision knee arthroplasty
  • satisfaction
  • subsidence
  • tantalum


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