Research & Innovation
Publications
A Cone Stacked on a Cone Within a Cone
PMU Author
Stefano Ghirardelli
All Authors
Stefano Ghirardelli, Peter Sculco, Jeffrey O'Donnell, Daniel Buchalter, Elizabeth Gausden, Brian Chalmers, Thomas Sculco
Journal association
ARTHROPLASTY TODAY
Abstract
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 & horbar;configured in both cone-in-cone and cone-on-cone fashion & horbar;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. (c) 2025 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
Keywords
BONE LOSS, Arthroplasty complication, Metaphyseal cone, Revision knee arthroplasty, Trabecular metal cone