Excellent mid-term osseointegration and implant survival using metaphyseal sleeves in revision total knee arthroplasty

Abstract

Purpose Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. Methods Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone–sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. Results No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. Conclusion No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. Level of evidence Retrospective cohort study, level III.

Reconstruction for massive proximal tibial bone defects using patient-customized three-dimensional-printed metaphyseal cones in revision total knee arthroplasty

“…It also shows signi cant improvement in patients' postoperative joint functions and knees ROM. Klim et al [20] conducted a 6.3-year follow-up of 93 RTKA with bone defects restored with metaphyseal sleeves. Not even a single case shows aseptic loosening.…”

Cementless Metaphyseal Sleeve Fixation in Revision Knee Arthroplasty: Our Experience with an Arabic Population at the Midterm

“…Studies have shown successful outcomes of MS in RKA with significant improvement in functional scores and excellent rate of osseointegration [ 26 – 28 ]. Implant survival rates of 94% to 100% have been reported at the midterm follow-up, with the endpoint being aseptic loosening [ 29 , 30 ]. Bloch et al recently reported a large series of 227 patients (319 RKA) using the MS (319 tibial and 146 femoral) with a mean follow-up of 7.6 years [ 30 ].…”

“…Similarly, another recent study by Kim et al which included 92 patients (93 RKA) with a mean follow-up of 6.3 years also demonstrated satisfactory results. The authors reported average improvements of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from 55 preoperatively to 9 postoperatively and the Subjective Satisfaction Score (SSS) from 2 preoperatively to 8 postoperatively (both p < 0.05) [ 29 ]. All patients in their series demonstrated optimal osseointegration at the final follow-up.…”

Prostheses option in revision total knee arthroplasty, from the bench to the bedside: (1) basic science and principles

“…If the bone defect is primarily manifested as substantial cavitary loss of cancellous bone at the metaphysis and the surrounding cortical bone is relatively intact, then augmentation, either in block or wedge, is not recommended for defect reconstruction ( 60 ). Instead, metaphyseal sleeves and cones are ideal alternatives to ensure a preferable clinical outcome ( 61 , 62 ). Generally, the geometry and appearance of sleeves and cones are analogical, but they have different design concepts and surgical techniques ( Fig.…”