• Stefano Divano, Luca Cavagnaro, Andrea Zanirato, Marco Basso, Lamberto Felli, and Matteo Formica.
• U.O. Clinica Ortopedica e Traumatologica, Ospedale Policlinico San Martino IST, largo R. Benzi 10, 16132, Genoa, GE, Italy. ste.divano@hotmail.com.
• Arch Orthop Trauma Surg. 2018 Jun 1; 138 (6): 851-863.

IntroductionRevision knee arthroplasty is increasing, and in that case, bone loss management is still a challenging problem. In the last years, the body of literature and interest surrounding porous metal cones has grown, but few systematic evaluations of the existing evidence have been performed. The aim of our systematic review is to collect and critically analyze the available evidence about metal cones in revision knee arthroplasty especially focusing our attention on indications, results, complications, and infection rate of these promising orthopaedic devices.Materials And MethodsWe performed a systematic review of the available English literature, considering the outcomes and the complications of tantalum cones. The combinations of keyword were "porous metal cones", "knee revision", "bone loss", "knee arthroplasty", "periprosthetic joint infection", and "outcome".ResultsFrom the starting 312 papers available, 20 manuscripts were finally included. Only one included study has a control group. The main indication for metal cones is type IIb and III defects according AORI classification. Most of the papers show good clinical and radiological outcomes with low rate of complications.ConclusionThe examined studies provide encouraging clinical and radiological short-to-mid-term outcomes. Clinical studies have shown a low rate of aseptic loosening, intraoperative fractures, infection rate and a lower failure rate than the previous treatment methods. Higher quality papers are needed to draw definitive conclusions about porous metal cones.

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