Metaphyseal cones in revision total knee arthroplasty

Shuqiao Xie, Noel Conlisk, David Hamilton, Chloe Scott, Richard Burnett, Pankaj Pankaj*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
1 Downloads (Pure)


AIMS: Metaphyseal tritanium cones can be used to manage the tibial bone loss commonly encountered at revision total knee arthroplasty (rTKA). Tibial stems provide additional fixation and are generally used in combination with cones. The aim of this study was to examine the role of the stems in the overall stability of tibial implants when metaphyseal cones are used for rTKA.

METHODS: This computational study investigates whether stems are required to augment metaphyseal cones at rTKA. Three cemented stem scenarios (no stem, 50 mm stem, and 100 mm stem) were investigated with 10 mm-deep uncontained posterior and medial tibial defects using four loading scenarios designed to mimic activities of daily living.

RESULTS: Small micromotions (mean < 12 µm) were found to occur at the bone-implant interface for all loading cases with or without a stem. Stem inclusion was associated with lower micromotion, however these reductions were too small to have any clinical significance. Peak interface micromotion, even when the cone is used without a stem, was too small to effect osseointegration. The maximum difference occurred with stair descent loading. Stress concentrations in the bone occurred around the inferior aspect of each implant, with the largest occurring at the end of the long stem; these may lead to end-of-stem pain. Stem use is also found to result in stress shielding in the bone along the stem.

CONCLUSION: When a metaphyseal cone is used at rTKA to manage uncontained posterior or medial defects of up to 10 mm depth, stem use may not be necessary. Cite this article: Bone Joint Res. 2020;9(4):162-172.

Original languageEnglish
Pages (from-to)162-172
Number of pages11
JournalBone and Joint Research
Issue number4
Publication statusPublished - 17 Apr 2020


  • bone defect
  • end-of-stem pain
  • finite element analysis
  • interfacial micromotion
  • von Mises stress

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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