Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-Customized Three-Dimensional-Printed Metaphyseal Cones in Revision Total Knee Arthroplasty.

Objective: To review the clinical outcomes of revision total knee arthroplasty (RTKA) with massive proximal tibial bone defects using patient-customized three-dimensional (3D) printed highly porous metaphyseal cones.

Methods: A retrospective study of all patients at our institution who underwent RTKA with the Anderson Orthopaedic Research Institute type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones was performed from 2016 to 2018. Seven patients were enrolled in this study. General results (age, sex, and body mass index); intraoperative results (interface compatibility and stability, and operating time); and perioperative complications (total blood loss, blood transfusion rate, and deep venous thrombosis) were recorded and analyzed. Clinical improvement and functional evaluation (survivorship of implant, improvement of Hospital for Special Surgery Score and McMaster Universities Osteoarthritis Index, and improvement of range of motion [ROM]), and radiographic improvement and implant evaluation (progressive radiolucent lines or radiographic loosening, and mechanical alignment) were evaluated at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and then annually, postoperatively.

Results: The mean age at diagnosis was 68 (61-77) years. The mean follow-up was 25.3 (19-36) months. At the latest follow-up, no aseptic loosening, prosthetic joint infection, or other complications were noted. The mean Hospital for Special Surgery Score increased from 49 (39-63) to 78 (70-83) (P < 0.01), whereas the mean Western Ontario and McMaster Universities Osteoarthritis Index increased from 59 (46-73) to 26 (12-38) (P < 0.01). All patients achieved improved postoperative ROM with the mean flexion angle increasing from 66° (30°-80°) to 93° (80°-100°), and improved mechanical alignment with all hip-knee-ankle (HKA) angles within ±3°.

Conclusions: The patient-customized 3D-printed metaphyseal cone is useful technique for reconstructing massive proximal tibial bone defects, with encouraging clinical and radiological outcomes in RTKA.