A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty
Bone loss in revision total knee arthroplasty is an increasing challenge, especially as younger active patients undergo primary procedures. Treatment options for severe tibial bone loss include cement, allograft, metal augments, metaphyseal cones, sleeves, and megaprostheses. Novel combinations of t...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-08-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344125001499 |
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| author | Stefano Ghirardelli, MD Peter Sculco, MD Jeffrey O'Donnell, MD Daniel Buchalter, MD Elizabeth Gausden, MD Brian Chalmers, MD Thomas Sculco, MD |
| author_facet | Stefano Ghirardelli, MD Peter Sculco, MD Jeffrey O'Donnell, MD Daniel Buchalter, MD Elizabeth Gausden, MD Brian Chalmers, MD Thomas Sculco, MD |
| author_sort | Stefano Ghirardelli, MD |
| collection | DOAJ |
| description | Bone loss in revision total knee arthroplasty is an increasing challenge, especially as younger active patients undergo primary procedures. Treatment options for severe tibial bone loss include cement, allograft, metal augments, metaphyseal cones, sleeves, and megaprostheses. Novel combinations of these have enabled complex limb salvage without resorting to megaprostheses or amputation. This case report presents a technique utilizing three cones—configured in both cone-in-cone and cone-on-cone fashion—to bypass and stabilize a metadiaphyseal fracture during revision total knee arthroplasty. We outline the indications for selecting each construct and explain how to achieve axial and rotational stability in different bone zones using patient-specific cones. This approach provides an alternative to traditional reconstruction methods in complex cases with significant bone loss and periprosthetic fracture. |
| format | Article |
| id | doaj-art-997a8a30c12a4f959f12c1619c2ab3e5 |
| institution | Kabale University |
| issn | 2352-3441 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj-art-997a8a30c12a4f959f12c1619c2ab3e52025-08-20T03:50:07ZengElsevierArthroplasty Today2352-34412025-08-013410176210.1016/j.artd.2025.101762A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee ArthroplastyStefano Ghirardelli, MD0Peter Sculco, MD1Jeffrey O'Donnell, MD2Daniel Buchalter, MD3Elizabeth Gausden, MD4Brian Chalmers, MD5Thomas Sculco, MD6Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA; Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria; Corresponding author. 535 E 70st Street, New York, NY 10021, USA. Tel.: +1 646 866 3781.Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USABone loss in revision total knee arthroplasty is an increasing challenge, especially as younger active patients undergo primary procedures. Treatment options for severe tibial bone loss include cement, allograft, metal augments, metaphyseal cones, sleeves, and megaprostheses. Novel combinations of these have enabled complex limb salvage without resorting to megaprostheses or amputation. This case report presents a technique utilizing three cones—configured in both cone-in-cone and cone-on-cone fashion—to bypass and stabilize a metadiaphyseal fracture during revision total knee arthroplasty. We outline the indications for selecting each construct and explain how to achieve axial and rotational stability in different bone zones using patient-specific cones. This approach provides an alternative to traditional reconstruction methods in complex cases with significant bone loss and periprosthetic fracture.http://www.sciencedirect.com/science/article/pii/S2352344125001499Revision knee arthroplastyBone lossMetaphyseal coneTrabecular metal coneArthroplasty complication |
| spellingShingle | Stefano Ghirardelli, MD Peter Sculco, MD Jeffrey O'Donnell, MD Daniel Buchalter, MD Elizabeth Gausden, MD Brian Chalmers, MD Thomas Sculco, MD A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty Arthroplasty Today Revision knee arthroplasty Bone loss Metaphyseal cone Trabecular metal cone Arthroplasty complication |
| title | A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty |
| title_full | A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty |
| title_fullStr | A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty |
| title_full_unstemmed | A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty |
| title_short | A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty |
| title_sort | cone stacked on a cone within a cone a technique for reconstructing proximal third tibial shaft fractures during revision total knee arthroplasty |
| topic | Revision knee arthroplasty Bone loss Metaphyseal cone Trabecular metal cone Arthroplasty complication |
| url | http://www.sciencedirect.com/science/article/pii/S2352344125001499 |
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