Master Techniques in Orthopedic Surgery Knee CH21

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21 Managing Bone Loss with Metaphyseal Cones

FIGURE 21-10. An intramedullary reamer that is stable within the tibial canal is impacted in preparation for the central symmetric cone reamer.

FIGURE 21-11. The central symmetric cone reamer is inserted to a specific depth that corresponds to the size of the three-dimensional printed titanium cone.

●● Preparation of the femoral cone includes a central symmetric that is placed to a certain depth that corresponds to the size of the femoral cone (Figure 21-14). ●● Next, an intramedullary device is placed in the femur at the corresponding depth and in the ap- propriate amount of external rotation (Figure 21-15). This allows for smaller side reamers to mill out the bone for the bilobe design (Figure 21-16).

FIGURE 21-12. A, The trial cone is impacted into the milled bone, ensuring the score mark is in line with the tibial crest for rotation. B, The real 3D printed titanium tibial cone is similarly impacted. A B