Metaphyseal cones and sleeves are similar in improving short- and mid-term outcomes in Total Knee Arthroplasty revisions

Abstract

PurposeThe purpose of this systematic review and metanalysis was to assess clinical and radiological outcomes of metaphyseal sleeves and cones and to identify their possible advantages and disadvantages. MethodsA comprehensive search from the inception of the databases to March 2021 was performed on Medline, Scopus, CINAHL, Cochrane, Embase, Ovid, and Google scholar databases. Coleman Methodology Score was used for quality assessment. Author, year of publication, type of study, level of evidence, sample size, number of patients, number of knees treated, mean age, gender, mean follow‐up, clinical outcomes, complications, the reason for revision and, type of prosthesis were extracted for analysis. Clinical studies providing data about patient’s outcomes after the primary and Total Knee Arthroplasty revision with the usage of sleeves or cones and a minimum of 2 years of follow‐up were included. ResultsThe literature search and cross‐referencing resulted in a total of 93 articles, but only 30 articles were appropriate for the systematic review. Comparable clinical results were reported between cones and sleeves. The meta‐analysis showed a greater incidence of intraoperative fractures in patients treated with sleeves (1.6%, [95% CI 0.7; 3.4] in cones and 4.6%, [95% CI 3.3; 6.4] in sleeves, p = 0.01), while the risk of postoperative fractures (4.3%, [95% CI 2.7; 7] in cones and 2.1%, [95% CI 1.2; 3.5] in sleeves, p = 0.04) and infections (8.5%, [95% CI 6; 12] in cones and 3.7%, [95% CI 2.1; 7.3] in sleeves, p = 0.03) was higher with cones. ConclusionA higher incidence of intraoperative fracture was reported in patients treated with sleeves, while a higher rate of postoperative fractures and infections was described in patients treated with cones. Nonetheless, complications were reported in both groups. Level of evidenceIII.

Metaphyseal Metal Sleeves for Reconstruction of Severe Knee Bone Defects: Excellent Survival Rate at a Mean Follow‐Up of 6.4 Years

“…Both cones and sleeves can be used to treat severe bone defects in the knee metaphysis, and there is no clear advantage of one method over the other in terms of survival as well as clinical outcomes 17–19 . In a meta‐analysis, Fischer et al .…”

“…Both cones and sleeves can be used to treat severe bone defects in the knee metaphysis, and there is no clear advantage of one method over the other in terms of survival as well as clinical outcomes. 17 , 18 , 19 In a meta‐analysis, Fischer et al . noted a higher rate of periprosthetic joint infection after rTKA using the cones compared to the sleeves, despite similar survival rates for both.…”

“…2,8,16 Both cones and sleeves can be used to treat severe bone defects in the knee metaphysis, and there is no clear advantage of one method over the other in terms of survival as well as clinical outcomes. [17][18][19] In a meta-analysis, Fischer et al noted a higher rate of periprosthetic joint infection after rTKA using the cones compared to the sleeves, despite similar survival rates for both. 17 Small et al retrospectively compared 225 patients with cones and 242 patients with sleeves, and they suggested that there was no significant difference between the two implants and that surgeons should be comfortable using either implant with confidence to manage severe bone loss in rTKA.…”

Excellent mid‐ to long‐term survival of tantalum metal cones in a case series of revision knee arthroplasty with severe bony defects

“…However, several papers have also shown excellent mid- to long-term survival rates for sleeves [ 7 , 11 , 16 , 21 ]. In two recent meta-analyses and one large consecutive series comparing cones and sleeves, the survival rates were comparable [ 15 , 23 , 36 ].…”