Medium term clinical outcomes of tibial cones in revision knee arthroplasty

Érivan, Roger; Tracey, Robert W.; Mulliez, Aurélien; Villatte, Guillaume; Paprosky, Wayne G.

doi:10.1007/s00402-020-03532-1

Cited by 10 publications

(12 citation statements)

References 26 publications

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“…Of the 22 included studies, two studies were performed in Germany [ 35 , 36 ], ten in the USA [ 7 , 16 , 37 – 44 ], four in Canada [ 45 – 48 ], two in the United Kingdom [ 49 , 50 ], two in France [ 51 , 52 ], one in Finland [ 53 ], and one in Russia [ 54 ] (Table 1 ). All studies were observational, of which 16 were retrospective cohort studies [ 16 , 35 – 37 , 40 , 42 , 43 , 45 – 49 , 52 – 54 ], and six were prospective cohort studies [ 7 , 38 , 39 , 41 , 44 , 50 ]. The total number of patients in the 22 studies was 2,462 (range 14 – 308).…”

Section: Resultsmentioning

confidence: 99%

“…None of the included studies had a low risk of bias, 20 studies had a moderate risk [ 7 , 16 , 36 – 44 , 46 – 54 ] and two studies had a high risk [ 35 , 45 ]. Most stars (equivalent to the lowest risk of bias) were awarded for the item “ascertainment of exposure”, since all 22 studies reported on rKA patients.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies reported on the UCLA score (12 studies) [ 16 , 36 , 37 , 40 , 42 , 43 , 45 – 50 ], four studies reported on LEAS [ 38 , 39 , 41 , 44 ], four studies reported on activity-related KOOS subscales [ 7 , 41 , 43 , 51 , 53 , 54 ], two studies reported on the Devane activity score [ 52 , 54 ], and one study reported on the Tegner activity score [ 35 ]. The 12 studies describing UCLA scores ( n = 965) found a mean UCLA score of 3.3 (± 1.9) preoperatively and 5.2 (± 2.3) postoperatively.…”

Section: Resultsmentioning

confidence: 99%

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Physical activity after revision knee arthroplasty including return to sport and work: a systematic review and meta-analysis including GRADE

Wilk

Hoorntje

Blankevoort

et al. 2023

BMC Musculoskelet Disord

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Background The number of primary knee arthroplasties (KAs) performed annually is rising, especially among active, working age patients. Consequently, revision KA is also increasingly performed. Our aim was to systematically review the extent to which patients were physically active following revision KA, and the rate and timing of return to sport and work. Methods A search was conducted in the databases Medline and Embase until February 24th, 2023. Studies describing patients with revision total knee arthroplasty (rTKA) or revision unicondylar knee arthroplasty (rUKA), with outcomes regarding physical activity or return to sport (RTS) or work (RTW) were included. Quality of studies was assessed using the Newcastle–Ottawa scale, meta-analyses were performed using RevMan 5.4 and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results Of the 4,314 articles screened, 22 studies were included describing 2,462 rTKA patients (no rUKA), 42% were male with a mean age of 67 years (range 24 – 95). No studies reported objective physical activity measurements. Twenty-two studies reported patient reported outcome measures (PROMs). The PROMs that were pooled on a scale from zero to ten were the UCLA Activity Score, the Tegner Activity Level Scale, the Lower-Extremity Activity Scale, Devane Activity Score, and physical activity related subscales of the Knee injury and Osteoarthritis Outcome Score. The retrospective studies of moderate quality showed a statistically significant postoperative improvement of 1.7 points (MD = 1.71, 95% CI 1.48 – 1.94 (p < 0.0001); 14 studies, n = 1,211). For the prospective moderate-quality studies, a statistically significant postoperative increase of 0.9 points was found (MD = 0.89, 95% CI 0.48 – 1.30 (p < 0.0001); 6 studies, n = 1,027). Regarding RTS, 12% of patients participated in so-called ‘non-recommended’ activities (i.e., hockey, soccer, football, gymnastics, jogging, singles tennis, and basketball) after rTKA (1 study, n = 206). The pooled RTW was 86% (2 studies, range 18–95%, n = 234). Conclusions The majority of patients self-reported an improved postoperative activity level after rTKA. Patients could maintain an active lifestyle in daily life, including sports and work. For reliable physical activity, RTS and RTW estimations, more studies are required. In terms of GRADE, the quality of evidence for the five prospective studies was rated as low. Level of evidence Level 3.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Physical activity after revision knee arthroplasty including return to sport and work: a systematic review and meta-analysis including GRADE

Wilk

Hoorntje

Blankevoort

et al. 2023

BMC Musculoskelet Disord

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“…They found a 100% 5-year survivorship free of revision for aseptic loosening and 93.4% for all-cause revision. 11 Martin-Hernandez et al reported on their medium-term outcomes using metaphyseal sleeves with a constrained implant and found a 100% aseptic survival rate at an average follow-up of 6 years with maximum follow-up of 8.9 years. 23 Bonanzinga et al 31 performed a systemic review of metaphyseal sleeves, including 928 knees, over an average of 45 months.…”

Section: The Key Is the Metaphysismentioning

confidence: 99%

“…4 ). 9 10 11 12 13 14 15 16 More recently, 3D-printed titanium cones have been developed with associated proprietary bone preparation instrumentation. These have demonstrated similar stability in both the femur and tibia 17 and promising short-term results 18 19 20 ; however, mid- and long-term results have yet to be revealed.…”

Section: Zone 2: the Metaphysismentioning

confidence: 99%

Zonal Fixation in Revision TKA: The Key Is Metaphyseal Fixation

Scuderi²

2021

J Knee Surg

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As the volume of primary total knee arthroplasties continues to rise, so will the volume of revision arthroplasties. Bone loss is commonly encountered in revision surgery and must be managed appropriately to optimize outcomes. The concept of zonal fixation highlights the importance of attaining secure fixation within each of the three major osseous zones: the epiphysis, the metaphysis, and the diaphysis. While each zone is important, the metaphysis carries particular significance. The development of new implants such as metaphyseal cones and sleeves has greatly expanded the orthopedic surgeon's armamentarium to allow for solid metaphyseal fixation in virtually every case.

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