The Open Orthopaedics Journal

ISSN: 1874-3250 ― Volume 14, 2020

A Case Report: Custom Made Porous Titanium Implants in Revision: A New Option for Complex Issues

Giorgio Burastero1, Luca Cavagnaro1, *, Francesco Chiarlone2, Bernardo Innocenti3, Lamberto Felli2
1 Department of Orthopaedic and Traumatology 2, Joint Replacement Unit, Azienda Ospedaliera Santa Corona, via XXV Aprile 38 Pietra Ligure (SV), Italy
2 Department of Orthopaedic, Policlinico San Martino Largo Rosanna Benzi 10, 16132 GENOVA, (GE), Italy
3 Department of BEAMS, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium



Bone loss management is considered one of the most difficult challenges for orthopaedic surgeon. In massive bone defects, few surgical options are available and they do not offer a reliable or optimal solution for knee reconstruction.


The aim of this paper is to present and justify a new custom-made approach for complex metadiaphyseal bone defects management in knee revision surgery.


We report a case of a 66-year-old woman who underwent a staged left total knee arthroplasty revision for infection with Anderson Orthopaedic Research Institute classification III uncontained femoral and tibial metadiaphyseal bone defects following five prior surgeries. Along with a case discussion, we describe clinical and radiological outcomes of 3 similar patients treated with this new custom-made device.


To manage these problems, we developed new, custom porous titanium devices for both femoral and tibial reconstruction tailored to a patient’s specific bone loss. Since, 2014, we treated four cases using custom-made porous titanium cones and we had optimal clinical and radiological results, with no instances of loosening, component migration, or mismatches between preoperative planning and intraoperative findings.


In extremely selected cases, this new device can be considered a possible and viable surgical step between “off the shelf” reconstruction implants and knee substitution with a tumor megaprosthesis.

Keywords: Revision TKA, Periprosthetic joint infection, Bone defect, Custom made, Novel implant, Porous titanium, Porous metal, Outcome.

Article Information

Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 525
Last Page: 535
Publisher Id: TOORTHJ-12-525
DOI: 10.2174/1874325001812010525

Article History:

Received Date: 9/7/2018
Revision Received Date: 14/11/2018
Acceptance Date: 20/11/2018
Electronic publication date: 30/11/2018
Collection year: 2018

© 2018 Burastero et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthopaedic and Traumatology 2, Joint Replacement Unit, Azienda Ospedaliera Santa Corona, via XXV Aprile 38 Pietra Ligure (SV), Italy; Tel: + 39 3333011814; E-mail:

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