LONG-TERM OUTCOMES OF METAPHYSEAL CONES IN REVISION TOTAL KNEE ARTHROPLASTY: A RETROSPECTIVE STUDY OF 256 CASES

Introduction Bone loss remains one of the challenges in revision total knee arthroplasty (rTKA). Trabecular Metal (TM) metaphyseal cones have been increasingly used to achieve stable fixation. While short- and mid-term results are promising, long-term outcomes remain poorly documented. The objective of this study was to evaluate implant survivorship, complication rates, and clinical outcomes at long-term follow-up in revision TKA using trabecular metal cones. Methods A retrospective analysis of 318 rTKAs performed for aseptic reason between 2011 and 2021 in a single center was conducted. All patients underwent rTKA with metaphyseal cones and cemented stemmed components. The mean age at surgery was 67 years, with a mean BMI of 29. Implant constraint included hinged prostheses in 60% and constrained condylar knee (CCK) for others. Stems were cemented in all patients, with short stems (<10cm) used in 47% and longer stems in 53 %. The following outcomes were analyzed: implant survivorship, complications, clinical outcomes assessed by KOOS score. The mean follow-up was 9 years (range 5–15 years). Results At 10 years, implant survivorship free from cone or prosthesis removal for any cause was 83%, while survivorship free from any reoperation was 72%. The main cause of reoperation was periprosthetic joint infection. There was no statistically significant difference in implant survivorship according to the level of prosthetic constraint (hinged vs CCK). Similarly, the length of cemented stems (short vs long) did not significantly influence implant survivorship. The mean KOOS score at final follow-up was 65. Conclusion Metaphyseal trabecular metal cones provide reliable and durable fixation in revision TKA, regardless of bone loss severity or implant constraint. Long-term results demonstrate a low rate of mechanical loosening at 10 years. Metaphyseal cones represent an effective solution to restore stability and function in complex revision TKA.