Table 1 Summary of the characteristics and outcomes of the included studies
No | Study author and year | Study design | Group(s) | Population (Knees) | Revision indication | Follow-up (months, mean ± SD or range) | Total re-revision rate | Infection rate (PJI) | Subsequent infection (recurrence of PJI) | Conclusion about the effectiveness of tantalum in terms of infection | Tantalum details |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Chalmers 2021 [29] | Retrospective cohort | Highly porous metaphyseal tibial cone in revision TKA | 178 | Aseptic loosening: = 75 (46%) Chronic PJI = 46 (28%) Instability = 24 (15%) Peri-prosthetic fracture = 8 (5%) Arthrofibrosis = 5 (3.0%) Suspected metal hypersensitivity = 5 (3.0%) | 30 (24–48) | 7 (4%) | 10 (5.6%) | NA | NA | Porous metaphyseal tibial cones |
2 | Rajgopal 2021 [34] | Retrospective cohort | TM cones for severe bone loss in primary and revision TKA | Revision = 48 Total = 62 | Loosening + periprosthetic joint infection + polywear = 38 Periprosthetic fracture = 10 | 110 (60–156) | 3 (5%) | 2 (4.2%) | NA | TM cones demonstrated favorable clinical/radiological outcomes and reasonable therapeutic options against severe bone defects during primary/revision TKA | Porous TM cones |
3 | Erivan 2021 [30] | Retrospective cohort | Tibial cones in revision TKA with a severe proximal tibial bone defect | 61 | The second stage after infection = 2 Aseptic loosening = 55 Instability = 3 Rotational problem = 1 | Minimum 24-month | 5 (8.2%) | 4 (6.5%) | NA | The present study of cones used for tibial revision shows excellent results | TM cones |
4 | Abdelaziz 2020 [36] | Retrospective cohort | Tantalum cones in one-stage knee exchange for PJI | 72 | PJI | 49.9 ± 18.8 | 15 (21%) | 8 (11.1%) | 8 (11.1%) | The first study reports on outcomes of the 1-stage exchange using Ta cones for knee periprosthetic joint infection with additional severe bone loss. Midterm cone-related and infection-free survival offered good results and provided reasonable functional outcomes | Porous Ta cones |
5 | Abdelaziz 2019 [37] | Retrospective cohort | Hinged knees and Ta cones | 32 | Aseptic loosening in all cases femoral component = 9 Tibial component = 9 Both components = 7 | 126.5 (120–142) | 8 (25%) | 3 (9.4%) | NA | Porous Ta cones in revision TKA exhibited no favorable but reasonable long-term durability. Rotating-hinge designs should be used whenever possible to reduce the risk of aseptic loosening | Ta cones |
6 | Rajgopal 2019 [55] | Retrospective cohort | Ta TM cones for severe distal femoral bone deficiency (stacked two-cone arrangement) | 11 (after excluding primary TKA) | Septic loosening = 5 Periprosthetic fracture = 3 Aseptic loosening = 3 | 57 | 0 (0%) | 0 (0%) | NA | The use of stacked cones in selected cases of severe distal femoral deficiency has an acceptable outcome | Ta TM cones |
7 | Panda 2019 [54] | Retrospective cohort | TKA patients requiring metaphyseal reconstruction for large femoral or tibial defects using porous tantalum cones | 59 | PJI = 26 Aseptic loosening = 17 Periprosthetic fracture = 7 Component malpositioning = 3 Varus malalignment = 2 Osteolysis = 2 Polyethylene wear = 2 | 83 (50–95) | 3 (5.1%) | 2 (3.4%) | NA | TM cones are a practical option for treating severe bone defects during TKA with predictable osteointegration and good long-term clinical outcomes | Porous Ta cones |
8 | Burastero 2018 [28] | Retrospective cohort | Ta metaphyseal cones | 60 | Staged revision for periprosthetic knee infection = 60 | 43.5 ± 17.4 | 2 (3.3%) | 2 (3.3%) | 2 (3.3%) | Excellent clinical and radiographic midterm outcomes were achieved with a low complication rate. Ta cones may be considered a safe and effective option in the management of massive bone defects and septic knee revision surgery | Ta cones |
9 | Kukreja 2018 [32] | Case Series | Tibial Ta cones without metallic augments | 6 | Aseptic = 5 Two-stage infected revision = 1 | 49.2 (18–72) | 1 (16.7%) | 0 (0%) | 0 (0%) | The “Tibial base plate-cone without augments (BCCA)” type of construct may offer a valid long-term advantage over the tibial base plate-augment-cone combination in massive tibial bone defects | Tibial Ta cones without metallic augments |
10 | Bohl 2018 [27] | Retrospective cohort | Ta metaphyseal cones to manage bone defects | 98 | NA | 42) 24–120) | NA | NA | NA | Metaphyseal cones are not associated with superior outcomes at short-term follow-up. Given the increased cost associated with using cones compared to traditional techniques, this study cannot support the routine use of metaphyseal cones in revision TKA | Ta metaphyseal cones |
Group 1: Ta Cone | 49 | Aseptic loosening = 16 (33%) Infection = 12 (25%) Instability = 12 (25%) Malrotation = 2 (4%) Periprosthetic fracture = 1 (2%) Stiffness = 6 (12%) | 40.5 ± 16.4 | 0 (0%) | 3 (6.1%) | 2 (16.6%) | |||||
Group 2: Non-cone | 49 | Aseptic loosening = 16 (33%) Infection = 12 (25%) Instability = 12 (25%) Malrotation = 2 (4%) Periprosthetic fracture = 1 (2%) Stiffness = 6 (12%) | 44.3 ± 19.4 | 2 (4%) | 5 (10.2%) | 1 (8.3%) | |||||
11 | Sandiford 2017 [35] | Retrospective cohort | TM cones and femoral head allografts in revision TKA | 45 | Aseptic loosening = 37 Instability = 2 Infection = 2 Periprosthetic fracture = 2 | 87 (60–108) | NA | NA | NA | No significant difference in function, pain, or recurrent revision was observed in comparison with either TM cones or femoral head allografts in the context of severe bone defects following revision TKA | TM cone |
Group 1: TM augments in TKA | 15 | NA | 0 (0%) | 0 (0%) | NA | ||||||
Group 2: Femoral head allografts | 30 | NA | 109 (72–144) | 2 (6.7%) | 1 (3.3%) | NA | There was no significant difference between the groups | ||||
12 | Girerd 2016 [31] | Retrospective cohort | TM cones | 52 Knees (51 patients) | Aseptic loosening = 22(42%) Infection = 19 (37%) Instability = 1(2%) Abnormality of the patella or extensor mechanism = 2(4%) Unexplained pain = 2(4%) Osteolysis and/or polyethylene wear = 3 (6%) Mechanical implant failure = 1(2%) Stiffness = 1(2%) Other = 1(2%) | 28 (21–32) | 4 (7.8%) | 4 (7.8%) | 4 (21.1%) | TM cones employed to fill metaphyseal and/or epiphyseal bone defects amid revision TKA provided promising outcomes comprising evidence of osteointegration, direct fixation, and favorable short-term stability even in infected patients | Metaphyseal and/or epiphyseal cone |
13 | Potter 2016 [33] | Retrospective cohort | Ta metaphyseal femoral cones in revision TKA | 159 Knees (157 patients) | Infection = 75 Aseptic loosening = 56 Osteolysis = 26 Implant failure = 16 Instability = 11 Fracture = 1 | 60 (24–120) | 23 (14.4%) | 14 (8.8%) | 13 (17.3%) | The survivorship in the subgroup with infection was virtually the same as that in the entire cohort, suggesting that failure rates of porous femoral cones do not increase in the infection settings | TM metaphyseal femoral cones |
14 | Boureau 2015 [39] | Case series | Porous Ta cones (2-cone technique) | 7 | Aseptic = 4 Septic revisions = 3 | 17 (12–25) | 0 (0%) | 0 (0%) | NA | Ta cone can be an alternative to allografts or mega-prostheses in case of massive bone defects | Porous Ta cones |
15 | Bédard 2015 [38] | Prospective cohort | All revisions (N = 115) | 115 | Aseptic Loosening = 32 Infection = 29 Instability = 27 Stiffness = 16 Implant breakage = 2 Extensor mechanism rupture = 2 Patella and malrotation = 1 | NA | NA | NA | NA | TM cones do not negatively influence the ability to achieve optimal mechanical alignment when using an uncemented stem technique in revision TKA | TM cones |
Group 1: Revisions with TM Cones | 21 | Aseptic Loosening = 13 Infection = 3 Instability = 2 Stiffness = 2 Implant Breakage = 1 | NA | 0 (0%) | 0 (0%) | 0 | NA | NA | |||
Group 1: Revisions without TM cones | 94 | Aseptic Loosening = 19 Infection = 26 Instability = 25 Stiffness = 14 Implant breakage = 1 Periprosthetic fracture = 6 Extensor mechanism rupture = 2 Patella and malrotation = 1 | NA | 0 (0%) | 1 (1.06%) | 1 (3.8%) | NA | NA | |||
16 | Brown 2015 [40] | Retrospective cohort | Revision TKA using TM cones | 83 | Complex primary = 4 Revision = 79: Aseptic loosening = 30 Infection = 21 Instability = 16 Stiffness = 6 Periprosthetic fracture = 3 Malalignment = 2 Traumatic arthrotomy and MCL failure = 1 | 40 (24–84) | 10 (12%) | 11 (13%) | 7 (33.3%) | TM cones represent an attractive option for managing bone loss in complex primary and revision TKA with a high rate of osseointegration | TM cones |
17 | Kamath 2015 [43] | Retrospective cohort | Porous Ta metaphyseal cones | 66 cones (63 patients) | Second-stage reimplantation for deep infection = 26 Aseptic loosening of the tibial component = 15 Severe tibial osteolysis in the presence of a well-fixed tibial component = 10 Fracture of the tibial component = 2 Periprosthetic tibial fracture = 1 Severe global knee instability with associated bone loss = 12 | 70 (60–106) | 3(5%) | 7(11%) | NA | Porous Ta tibial cones offer a promising management option for severe tibial bone loss. At the intermediate-term follow-up (5–9 years), porous Ta tibial cones had durable clinical results and radiographic fixation. The biological ingrowth of these implants offers the potential for successful long-term structural support in complex knee reconstructions | Porous Ta tibial cones |
18 | De Martino 2015 [42] | Retrospective cohort | Ta cones | 18 | Aseptic loosening = 5 Second-stage reimplantation for deep infection = 13 | 72 (60–96) | 2 (11.1%) | 2 (11.1%) | 2 (15.4%) | Ta cones for reconstructing massive bone defects in revision TKA yielded secure fixation with excellent results at an average follow-up of 6 years. These devices are viable for surgeons to use in situations with severe bone loss | Ta cones |
19 | Derome 2014 [41] | Retrospective cohort | Highly porous TM cone | 29 | Aseptic loosening/wear = 20 Second-stage revision after deep infection = 7 Periprosthetic fracture = 2 | 33 (13–73) | 2 (6.9%) | 2 (6.9%) | NA | Favorable short-term outcomes and low complication rate | Porous Ta cones |
20 | Jensen 2014 [45] | Retrospective cohort | TM cone | 36 | Aseptic loosening = 15 Deep infection = 15 Knee instability = 5 Severe knee pain without loosening of the implant = 1 | 40 (12–84) | 4 (11.1%) | 2 (5.6%) | 2 (13.3%) | TM cones can provide an effective treatment regarding surgical efficacy, clinical results, and radiological results. It may be at least as effective as the other options reviewed in the literature | TM cone |
21 | Villanueva-Martínez 2013 [15] | Retrospective cohort | All patients | 21 | Aseptic revision = 16 After sepsis = 5 | 36 | 1 (4.76%) | 2 (9.5%) | 2 (40%) | In the short term, porous Ta metaphyseal cones provided structural support for large femoral and tibial defects. They also provided the environment for bone graft osseointegration, repair of femoral fractures, and effective interdigitation of cement mantle into the TM cone | Ta cones |
22 | Rao 2013 [48] | Case series | TM cones with accompanying rotating hinged prosthesis | 29 Knees (26 Patients) | Aseptic loosening = 15 (51%) Peri-prosthetic fracture = 4 (14%) Infection = 9 (31%) | 36 (24 − 49) | 2 (7%) | 2 (7%) | 2 (22.2%) | Ta cones yield satisfactory outcomes, including pain relief and promising functional survival while managing major osteolytic defects | TM cones |
23 | Fosco 2013 [58] | Retrospective cohort | Porous TM cones | 11 Knees (10 Patients) | Deep infection = 4 (36%) Aseptic loosening = 5(45%) Malrotation of prosthetic components = 1(9%) Failed mega prosthesis tibial component, following a tumor resection = 1(9%) | 39.8 (24- 78) | 0 (0%) | 0 (0%) | 0 (0%) | No significant correlation was found between the employed TM cones and subsequent risk of re-infection | Cemented/cementless Ta cones |
24 | Schmitz 2013 [49] | Retrospective cohort | Porous Ta cones | 38 | Aseptic loosening of the tibial component = 12 Aseptic loosening of the femoral component = 12 Aseptic loosening of both components = 14 | 37 (35–42) | 2 (5.3%) | 0 (0%) | NA | The favorable clinical and radiological outcomes using TM cones in managing relevant bone loss in revision TKA were found | Porous Ta cones |
25 | Panni 2013 [47] | Retrospective cohort | Ta cone | 7 knees (out of 38 knees) | Second-stage for deep infection = 16 Aseptic loosening = 11 Osteolysis = 7 Pain = 2 Instability = 2 | 84 (54–144) | 0 (0%) | 0 (0%) | NA | Ta cones could provide well-functioning and durable revision TKAs | Ta cone |
26 | Lachiewicz 2012 [46] | Retrospective cohort | Ta metaphyseal cones in revision TKA | 27 knees (27 patients) | Infection = 13 Aseptic loosening = 10 Osteolysis/polyethylene wear = 4 | 42 (24–68.4) | 4 (14.8%) | 1 (3.7%) | 1 (7.7%) | Employing Ta cones for massive structural defects revision TKA represents a promising technique with a low infection rate and component loosening | TM metaphyseal cones |
27 | Howard 2011 [50] | Retrospective cohort | Ta femoral cones | 24 | Aseptic loosening of the femoral component = 11 Second-stage reimplantation for the treatment of deep infection = 7 Severe osteolysis around a well-fixed femoral component = 3 Periprosthetic femoral fracture = 2 Severe knee instability = 1 | 33 (24–50) | 0(0%) | 0 (0%) | 0 (0%) | During the short-term follow-up, the porous Ta metaphyseal femoral cones effectively provided structural support for the revision of TKA's femoral implants | Porous Ta metaphyseal cones |
28 | Long 2009 [53] | Retrospective cohort | Porous Ta cones | 16 | Aseptic loosening = 13 Infection = 3 | 31 (24–38) | 2 (12.5%) | 2 (12.5%) | 2 (66%) | Reconstructive tools achieved good short-term results in complex revisions | Porous Ta tibial cones |
29 | Meneghini 2008 [51] | Prospective cohort | Porous Ta metaphyseal tibial cones | 15 | Deep infection = 5 Aseptic loosening of the tibial component = 4 Severe tibial = 3 Fracture of the tibial component = 2 Severe global knee instability with associated bone loss = 1 | 34 (24–47) | 4 (26%) | 2 (13%) | NA | Porous Ta metaphyseal tibial cones may provide adequate structural support for the implants | Porous Ta metaphyseal cones |
30 | Radnay 2006 [52] | Case series | TM cone | 10 | NA | NA | 1 (10%) | 1 (10%) | NA | TM augments with stem fixation, an alternate technique with early clinical and radiographic success for reconstructions with severe bone loss | TM cone |