{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:57:19Z","timestamp":1792670239417,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100010109","name":"Medical University of Graz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010109","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100010109","name":"Medizinische Universit\u00e4t Graz","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010109","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Severe metaphyseal bone defects remain a challenge and represent a growing problem in revision total knee arthroplasty (RTKA). The purpose of this study was to examine the survival of first\u2010generation tantalum metal cones (TMC) and to assess clinical and radiographic data obtained from mid\u2010 to long\u2010term follow\u2010ups (FU) after RTKA with severe bony defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series included 100 consecutive patients of the same centre, who underwent RTKA surgery with TMC for tibia and\/or femur bone defects between January 2011 and December 2015. Fourteen patients had died and six were lost for FU, leaving a total of eighty patients (one hundred and twelve TMC) for final evaluation. Clinical parameters including the Knee Society Score (KSS), visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were determined preoperatively based on the patients\u2019 medical charts, and assessed again during the final FU after an average of 6.1 (5\u20139) years postoperative. Standardised postoperative X\u2010rays were analysed during the final FU visit for osseointegration of the cones, and any signs of implant loosening were assessed with the modified Knee Society Radiographic review criteria. Perioperative and postoperative complications, reoperations, as well as implant and cone re\u2010revisions were analysed. Survivorship analysis was performed with (a) cone\u2010related revision for any reason and (b) implant component revision for any reason.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Previous RTKA had to be performed due to 64 (80%) aseptic and 16 (20%) septic failures. At the final FU, 75 (94%) tibia and 76 (95%) femur TMCs and implants were clinically stable. One patient experienced loosening of cones and implants at the femur and tibia but denied re\u2010revision surgery. There were eight (10%) reoperations including two early wound healing problems, two inlay changes, two periprosthetic fractures, one debridement, antibiotics and implant retention (DAIR), and one secondary patella replacement. The six (7.5%) re\u2010revisions included two aseptic loosening\u2019s of the opposite implant without TMC, one arthrodesis for recurrent instability, and three deep infections managed by two two\u2010stage exchanges, and one amputation for persistent infection. At re\u2010revision, all TMC cones were osteointegrated without signs of loosening. The determined clinical parameters showed significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) postoperative improvement, and objective KSS was rated as excellent in 51%, and as good in 22% of patients at the final FU. The estimated 8\u2010year Kaplan\u2013Meier survival was 95% for TMC and 92.5% for implant components.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tantalum metal cones (TMC) demonstrate a secure fixation for treatment of severe femoral and tibial metaphyseal bone defects during RTKA. This fixation concept showed excellent mid\u2010 to long\u2010term clinical and radiographic outcomes with promising 8\u2010year survival rates for cones and implant components.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Retrospective cohort study, Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00167-023-07593-8","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T08:02:49Z","timestamp":1697011369000},"page":"5496-5506","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Excellent mid\u2010 to long\u2010term survival of tantalum metal cones in a case series of revision knee arthroplasty with severe bony defects"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-0972","authenticated-orcid":false,"given":"Michael","family":"Eder\u2010Halbedl","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology LKH Feldbach\u2010F\u00fcrstenfeld Ottokar\u2010Kernstock\u2010Stra\u00dfe 18 8330 Feldbach Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology Medical University of Graz Auenbruggerplatz 5 8036 Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Pietsch","sequence":"additional","affiliation":[{"name":"Department of Orthopedics LKH\u2010Murtal Stolzalpe Stolzalpe 38 8852 Murau Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Djahani","sequence":"additional","affiliation":[{"name":"Department of Orthopedics LKH\u2010Murtal Stolzalpe Stolzalpe 38 8852 Murau Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegfried","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology Medical University of Graz Auenbruggerplatz 5 8036 Graz Austria"},{"name":"Department of Orthopedics LKH\u2010Murtal Stolzalpe Stolzalpe 38 8852 Murau 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