Direct, Cementless, Metaphyseal Fixation in Knee Revision Arthroplasty With Sleeves—Short-Term Results

“…This is in keeping with reports by other authors [5,10,14]. We experienced no cases of infection, stem fractures, or stem tip pain as reported by Graichen et al [12]. With the numbers available, we found no difference in pain, function, or repeat revision when comparing femoral head structural allografts and trabecular metal cones for the management of severe bone defects during revision TKA.…”

Section: Resultssupporting

confidence: 76%

“…Lachiewicz et al [19] experienced no failures at 39-month followup in their cohort of 27 knees. In larger series, Kamath et al [16] reported [ 95% survivorship at an average 70-month followup, whereas Graichen et al [12] found 89% survivorship in 193 sleeves at a mean 42-month followup. The results of our study are comparable to the best published results with the use of femoral head allografts.…”

Section: Resultsmentioning

confidence: 99%

“…Survivorship for metaphyseal cones has been reported to be 85% to 100% [12,16,19] although the results are short term. To our knowledge, there are no published studies at medium term comparing these two techniques using validated patientreported outcome measures.…”

Section: Introductionmentioning

confidence: 83%

“…The latter authors found that the time to graft union was 6 to 7 months, in keeping with the results of this study. Alexander [6], Huang et al [15], Agarwal et al [1], and Graichen and colleagues [12] reported statistically significant improvements in the KSS, Oxford, and WOMAC scores at an average of 2 to 4 years postsurgery in patients treated using trabecular metal cones. Kamath et al [16] reported a KSS score of 80 points (representing a sustained improvement of 25 points) at a minimum 5-year followup with the use of trabecular metal cones.…”

Section: Resultsmentioning

confidence: 99%

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No Difference Between Trabecular Metal Cones and Femoral Head Allografts in Revision TKA: Minimum 5-year Followup

Sandiford

Misur

Garbuz

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Encouraging clinical results have been reported with the use of femoral head structural allografts and, more recently, trabecular metal cones for the management of large structural defects of the femur and tibia during revision total knee arthroplasty (TKA). However, to our knowledge, there are no published studies comparing these two techniques. Questions/purposes Compared with bulk allografts, do trabecular metal cones result in (1) better validated outcomes scores; (2) a lower risk of loosening or revision at 5 years; and (3) fewer surgical complications when used for the management of bone loss in revision TKA?Methods Between 2002 and 2008, three surgeons performed 450 TKA revisions, 45 (10%) of which were performed using augmentation of host bone; in those, femoral head allograft was used in 30 (75%) and trabecular metal cones in 15 (25%). From 2002 to 2007, femoral head allografts were used in all patients (28 patients); from 2007 to 2008, trabecular metal augments were used in all patients. There was a period of 1 year (16 knees) in which there was some overlap; during that time, femoral head structural allografts were used in cases in which we were unable to fit the defect or achieve adequate stability with trabecular metal cones. Followup was at a mean of 9 years (range, 5-12 years). No patients were lost to followup. Knee function and quality of life were assessed using the Oxford Knee Score, WOMAC, SF-12, and the UCLA activity score. Radiographs were assessed for signs of loosening. Surgical complications included superficial or deep infections, iatrogenic fractures, symptomatic deep venous thromboses or pulmonary emboli, and blood loss requiring transfusion; these were obtained from our database and from review of patients' charts. Results The mean Oxford Knee Score in the allograft and trabecular metal cone groups was 91 (SD 10) and 91 (SD 14), respectively (95% confidence interval [CI], 88-94; p = 0.29). Mean WOMAC scores were 94 (SD 10) and 92 (SD 14), respectively (95% CI, 80-105; p = 0.52) and mean UCLA scores were 6 (SD 1.2) and 6 (SD 1.5), respectively (95% CI, 4-8; p = 0.49). Five-and 10-year survivorship of the allografts was 93% (95% CI, 77-98) and 93% (95% CI, 77-99), respectively. Survivorship at a mean of 5 years in the trabecular metal cones group was 91% (95% CI, 56-98). With the numbers available, there were no differences between the groups in terms of the frequency of surgical complications (3% [one of 30] versus 7% [one of 15]; odds ratio, 0.5; p = 0.632).

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Femoral Bone Defects in Revision Total Knee Arthroplasty

Katchky

Backstein

2021

Evidence‐Based Orthopedics

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Direct, Cementless, Metaphyseal Fixation in Knee Revision Arthroplasty With Sleeves—Short-Term Results

Cited by 70 publications

References 21 publications

The use of metaphyseal sleeves in revision total knee arthroplasty

The use of metaphyseal sleeves in revision total knee arthroplasty

No Difference Between Trabecular Metal Cones and Femoral Head Allografts in Revision TKA: Minimum 5-year Followup

Femoral Bone Defects in Revision Total Knee Arthroplasty

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