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Should We Always Use a Metaphyseal Cone in Conjunction With Tibial Augments for Uncontained Defects? A Finite-element
Fernando J Quevedo González1, Andrew J Hughes2,3, Marco Brenneis4
1Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
Clinical Orthopaedics and Related Research
|September 10, 2025
Summary
Metaphyseal cones enhance revision total knee arthroplasty (TKA) construct stability, especially for bicompartmental defects. Medial augments showed minimal impact, suggesting cones are crucial for complex tibial reconstructions.
Area of Science:
- Biomechanical analysis of orthopedic implants
- Finite element modeling in joint replacement surgery
- Orthopedic implant biomechanics
Background:
- Revision total knee arthroplasty (TKA) requires careful implant selection for long-term fixation.
- Tibial defects are commonly addressed with augments and cones, but their biomechanical impact is unclear.
Purpose of the Study:
- To assess the impact of tibial augment thickness, location (medial vs. bicompartmental), and metaphyseal cones on revision TKA construct stability.
- To evaluate construct stability under stair ascent simulation and torsional loading conditions.
Main Methods:
- Patient-specific finite element models of revision TKA were created from CT scans.
- Simulations analyzed medial and bicompartmental defects (5-15mm) with and without metaphyseal cones.
- Interfacial stresses were calculated to determine the risk of cement-implant debonding under simulated daily activity and torsional loads.
Main Results:
- Bicompartmental augments negatively impacted construct stability, particularly under torsional loads (52% risk with cement alone).
- Medial augments showed minimal impact on stability when well-seated.
- Metaphyseal cones significantly increased construct stability, reducing the risk of debonding compared to cement alone.
Conclusions:
- Metaphyseal cones are vital for enhancing revision TKA construct stability, especially in cases with bicompartmental defects.
- Medial augments have a limited effect on stability, while bicompartmental augments require careful consideration, potentially necessitating cone use.
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