{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T18:26:49Z","timestamp":1792866409132,"version":"4.5.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,9,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Porous metaphyseal cones are frequently utilized during revision total knee arthroplasty (TKA) procedures. The purpose of the present study was to evaluate 3D-printed metaphyseal cones used for revision TKA, with specific emphasis on implant survivorship, radiographic appearance, and clinical outcomes after short-term follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We identified 740 cones (498 tibial, 242 femoral) that had been inserted during 533 revision TKA procedures that had been performed at a single tertiary care academic institution. Aseptic loosening (n = 199), periprosthetic joint infection (PJI) (n = 183), and instability (n = 84) were the most common reasons for the index revision. Type-2B or 3 bone loss was present in 67% of the knees. The mean age was 66 years, the mean body mass index was 34 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , and 55% of the patients were female. Serial radiographs were reviewed. The mean duration of follow-up was 4 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The 5-year cumulative incidence of cone revision for aseptic loosening was 1% (95% confidence interval [CI], 0% to 3%). The 5-year cumulative incidence of any cone revision or removal was 6% (95% CI, 4% to 9%). In total, 37 cones (19 femoral, 18 tibial) were revised, with PJI (n = 23; 14 recurrent), periprosthetic femoral fracture (n = 3), arthrofibrosis (n = 3), and aseptic loosening of the femoral component and femoral cone (n = 3) as the most common reasons for cone revision. The 5-year cumulative incidence of any TKA re-revision was 14% (95% CI, 11% to 18%). There were a total of 67 re-revisions, with PJI (n = 38), persistent drainage (n = 6), and extensor mechanism disruption (n = 3) being the most common reasons. Radiographically, 2 unrevised femoral cones and 1 unrevised tibial cone appeared to be possibly loose; all 3 cones were in knees with distal femoral replacements or hinged constructs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This large series showed that 3D-printed titanium metaphyseal cones were very durable at short-term follow-up, with a 5-year cumulative incidence of cone revision for aseptic loosening of 1%. PJI was the most common reason for cone revision and any revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.23.01196","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T14:11:27Z","timestamp":1718374287000},"page":"1688-1696","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["3D-Printed Metaphyseal Cones in Revision Total Knee Arthroplasties"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3535-5584","authenticated-orcid":false,"given":"Christopher N.","family":"Carender","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cole E.","family":"Bothun","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7636-0489","authenticated-orcid":false,"given":"Michael J.","family":"Taunton","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1457-442X","authenticated-orcid":false,"given":"Kevin I.","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3151-877X","authenticated-orcid":false,"given":"Nicholas A.","family":"Bedard","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1679-0046","authenticated-orcid":false,"given":"Mark W.","family":"Pagnano","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2398-1724","authenticated-orcid":false,"given":"Matthew P.","family":"Abdel","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"issue":"10","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"2938","DOI":"10.1016\/j.arth.2020.05.050","article-title":"Why Do Revision Total Knee Arthroplasties Fail? A Single-Center Review of 1632 Revision Total Knees Comparing Historic and Modern Cohorts","volume":"35","author":"Geary","year":"2020","journal-title":"J Arthroplasty."},{"issue":"6_Supple_A","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1302\/0301-620X.102B6.BJJ-2019-1544.R1","article-title":"Excellent two-year survivorship of 3D-printed metaphyseal cones in revision total knee arthroplasty","volume":"102-B","author":"Tetreault","year":"2020","journal-title":"Bone Joint J."},{"issue":"3","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.arth.2021.11.027","article-title":"Use of Cementless Metaphyseal Fixation in Revision Total Knee Arthroplasty in the United States","volume":"37","author":"Carender","year":"2022","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"78","DOI":"10.2106\/JBJS.F.01495","article-title":"Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement","volume":"90","author":"Meneghini","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"15","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.2106\/JBJS.15.00874","article-title":"Midterm Results of Porous Tantalum Femoral Cones in Revision Total Knee Arthroplasty","volume":"98","author":"Potter","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1016\/j.arth.2017.01.013","article-title":"Development and Verification of Novel Porous Titanium Metaphyseal Cones for Revision Total Knee Arthroplasty","volume":"32","author":"Faizan","year":"2017","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.arth.2021.10.027","article-title":"Survivorship and Radiographic Evaluation of Metaphyseal Cones With Short Cemented Stems in Revision Total Knee Arthroplasty","volume":"37","author":"Behery","year":"2022","journal-title":"J Arthroplasty."},{"key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.artd.2021.01.004","article-title":"Early Survivorship of Newly Designed Highly Porous Metaphyseal Tibial Cones in Revision Total Knee Arthroplasty","volume":"8","author":"Chalmers","year":"2021","journal-title":"Arthroplast Today."},{"issue":"10","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"873","DOI":"10.2106\/JBJS.16.00423","article-title":"Modular Fluted Tapered Stems in Aseptic Revision Total Hip Arthroplasty","volume":"99","author":"Abdel","year":"2017","journal-title":"J Bone Joint Surg Am."},{"key":"bib10-20250430","first-page":"167","article-title":"Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction","volume":"48","author":"Engh","year":"1999","journal-title":"Instr Course Lect."},{"issue":"15","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.2106\/JBJS.17.01165","article-title":"Extensor Mechanism Reconstruction with Use of Marlex Mesh: A Series Study of 77 Total Knee Arthroplasties","volume":"100","author":"Abdel","year":"2018","journal-title":"J Bone Joint Surg Am."},{"key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00003086-198911000-00003","article-title":"The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system","volume":"248","author":"Ewald","year":"1989","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1016\/j.arth.2015.05.049","article-title":"Development of a Modern Knee Society Radiographic Evaluation System and Methodology for Total Knee Arthroplasty","volume":"30","author":"Meneghini","year":"2015","journal-title":"J Arthroplasty."},{"key":"bib14-20250430","first-page":"116","article-title":"Cemented long-stem revision total knee arthroplasty","volume":"309","author":"Murray","year":"1994","journal-title":"Clin Orthop Relat Res."},{"key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00003086-198911000-00004","article-title":"Rationale of the Knee Society clinical rating system","volume":"248","author":"Insall","year":"1989","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.arth.2019.11.016","article-title":"Midterm Results After Tantalum Cones in 1-Stage Knee Exchange for Periprosthetic Joint Infection: A Single-Center Study","volume":"35","author":"Abdelaziz","year":"2020","journal-title":"J Arthroplasty."},{"issue":"12","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"3018","DOI":"10.1016\/j.arth.2019.06.057","article-title":"Clinical Survivorship of Aseptic Revision Total Knee Arthroplasty Using Hinged Knees and Tantalum Cones at Minimum 10-Year Follow-Up","volume":"34","author":"Abdelaziz","year":"2019","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"216","DOI":"10.2106\/JBJS.N.00540","article-title":"Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up","volume":"97","author":"Kamath","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1186\/s13018-020-02025-6","article-title":"Influence of a metaphyseal sleeve on the stress-strain state of a bone-tumor implant system in the distal femur: an experimental and finite element analysis","volume":"15","author":"Li","year":"2020","journal-title":"J Orthop Surg Res."},{"issue":"2","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1302\/0301-620X.97B2.34144","article-title":"Zonal fixation in revision total knee arthroplasty","volume":"97-B","author":"Morgan-Jones","year":"2015","journal-title":"Bone Joint J."},{"issue":"6","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-1934.R1","article-title":"Mid-term results of tibial cones : reasonable survivorship but increased failure in those with significant bone loss and prior infection","volume":"103-B","author":"Hernandez","year":"2021","journal-title":"Bone Joint J."},{"issue":"1","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3928\/01477447-20201202-04","article-title":"Short-term Outcomes of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty","volume":"44","author":"Remily","year":"2021","journal-title":"Orthopedics."},{"issue":"6","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-2504.R1","article-title":"3D-printed titanium metaphyseal cones in revision total knee arthroplasty with cemented and cementless stems","volume":"103-B","author":"Anderson","year":"2021","journal-title":"Bone Joint J."},{"issue":"1","key":"bib24-20250430","doi-asserted-by":"crossref","first-page":"48","DOI":"10.3109\/17453674.2014.964097","article-title":"Failure of aseptic revision total knee arthroplasties","volume":"86","author":"Leta","year":"2015","journal-title":"Acta Orthop."},{"key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/01.blo.0000138094.86911.55","article-title":"Reoperations after 3200 revision TKAs: rates, etiology, and lessons learned","volume":"425","author":"Sierra","year":"2004","journal-title":"Clin Orthop Relat Res."},{"issue":"6S","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1016\/j.arth.2021.12.026","article-title":"The Cost-Effectiveness of Tibial Metaphyseal Cones in Revision Total Knee Arthroplasty","volume":"37","author":"Serino","year":"2022","journal-title":"J Arthroplasty."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.01196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:08Z","timestamp":1787751848000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.01196"}},"subtitle":["Excellent Survivorship of 740 Cones at 5 Years"],"short-title":[],"issued":{"date-parts":[[2024,6,14]]},"references-count":26,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.23.01196","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,14]]}}}