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Master Thesis

L'utilisation des cônes en tantale pour la gestion des pertes de substance osseuse lors des reprises de prothèse totale de genou

Abstract : Introduction: revision knee arthroplasty is a difficult surgery that poses many problems, including the management of bone loss. There are several solutions to manage these bone losses, but the optimal solution has not been established yet. Recently, a new surgical technique using tantalum cones (ultra-porous metal) has devellopped with promising results. Purpose and hypothesis: the purpose of this study was to show that the use of tantalum cones for bone loss management of total knee arthroplasty is a reliable solution that improves clinical and functionnal scores, while allowing a good osseointegration of the implant ensuring its long-term durability. Methods: between april 2014 and august 2018, 60 patients, mean age 73 ans [38 – 91 yo], had a revison knee arthroplasty with use of tantalum cones on femur, tibia or both for bone loss AORI 2 or 3. The patients were assessed clinicaly with the knee ROM and the functional score (SF-12/Womac/IKS) and the satisfaction rate as well as on radiologics for the osseointegration. The evaluation was performed preoperatively and at the last follow-up. Results: at mean follow-up of 35 months [12-60 months], 39 patients were clinically and radiologically assessed; there was an average flexion gain of 14.9 ° [91.9 ° vs 106.8 °, p <0.0001]. The overall mean IKS score increased from 106.7 preoperatively to 147 at the last follow-up (p <0.0001). Mean WOMAC score increased from 52.8 to 27.9 (p <0.0001). The mean physical SF12 score increased from 33.2 to 39 (p <0.0001) and the mean mental SF12 score increased from 52 to 53.3 (p> 0.0001). The rate of satisfied patients was 82%. Radiologically, the average HKA angle was 180.7 ° [172 ° - 186 °] and all cones showed evidence of osseointegration. The overall complication rate of the series was 27%. The reoperation rate was 15% and the prosthesis revision rate was 3%. Conclusion: the use of tantalum cones for the management of bone loss in knee replacement is a reliable solution, which provides clinical improvement and good radiological results with cone osseointegration. It finds its place in the management of bone loss AORI 2B and 3.
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Daniel Ristic. L'utilisation des cônes en tantale pour la gestion des pertes de substance osseuse lors des reprises de prothèse totale de genou. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02497163⟩

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