Zonal Fixation in Revision TKA: The Key Is Metaphyseal Fixation

Oh, Jason; Scuderi, Giles R.

doi:10.1055/s-0041-1735281

Cited by 16 publications

(19 citation statements)

References 37 publications

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“…For these reasons epiphyseal bone loss is not significantly associated with implant selection in our revision cohort. However, bone loss involving the metaphysis was associated with the use of augments and larger metaphyseal bone loss was associated with the use of cones/sleeves indicating that the metaphysis drives implant selection and emphasises the important role of metaphyseal fixation in managing bone loss in rTKA [21].…”

Section: Discussionmentioning

confidence: 99%

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

Brenneis,

Flevas,

Braun

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe primary purpose of the study was to use pre‐revision total knee arthroplasty (TKA) computer‐tomography (CT)‐images to analyse typical tibial bone defects and create a new schematic three‐dimensional (3D)‐classification system. The secondary purpose was to investigate the association between defect size and implant selection at the time of revision surgery.MethodsEighty‐four patients with preoperative CT‐scans underwent revision of a primary TKA. CT‐image segmentation with the 3D‐Slicer Software was performed retrospectively, and a new three‐dimensional classification system was used to grade tibial bone defects. The location of tibial bone defects was recorded for all cases. Volumetric 3D bone defect measurements were used to investigate the association between the bone defect volume, the indication for rTKA, and the use of modular revision components. The t‐test, the Mann–Whitney‐U test, and the Fisher's exact‐test were used for group comparisons, and the Kruskal–Wallis test was used for multiple group comparisons.ResultsThe most common anatomic regions for both contained and uncontained tibial bone defects were the anteromedial epiphysis (N = 50; mean epiphyseal‐defect: 5.9 cm³) and metaphysis (N = 15; mean metaphyseal‐defect: 9.6 cm³). A significant association was found between patients with preoperative metaphyseal defects (N = 22) and the use of tibial augments (N = 7) (p = 0.04). The use of cones/sleeves was associated with a significantly increased 3D‐CT volume of the preoperative metaphyseal bone defects (p = 0.04). Patients with osteoporosis had significantly larger volumetric defects in the metaphysis (p = 0.01).ConclusionOur results emphasise the importance of considering the three‐dimensional nature of tibial defects in rTKA. The findings suggest that an understanding of the volume of the defect size through CT imaging can predict the need for augments and cones/sleeves and, especially in patients with osteoporosis can help the surgeon identify larger metaphyseal defects and ensure optimal metaphyseal fixation through appropriate implant selection.Level of EvidenceLevel III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

Brenneis,

Flevas,

Braun

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…In recent years, more attention has been paid to the fixation of the metaphyseal region 2–4 . The metaphyseal metal sleeve is a new option for reconstructing bone defects in the knee, with good survival rates reported in several publications 5,6 .…”

Section: Introductionmentioning

confidence: 99%

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

Liu,

Zhang,

Shen

et al. 2023

Orthopaedic Surgery

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ObjectiveManagement of bone loss in complex primary and revision total knee arthroplasty is key to the surgeries. Metaphyseal metal sleeves have been increasingly used recently to reconstruct severe knee metaphyseal bone defects. This study aimed to investigate the outcomes of the metaphyseal sleeve reconstructing Anderson Orthopedic Research Institute (AORI) type II and type III bone defects of knee joint.MethodsFrom 2014 to 2019, a total of 44 knees were enrolled in this clinical retrospective study after the screening, including seven cases of primary TKA and 37 cases of revision TKA. The types of bone defects involved in this study were AORI types II and III, and did not involve AORI type I bone defects. Patients' knee function preoperatively and postoperatively as well as quality of life were recorded and analyzed. Analysis included the American Knee Society Score (KSS), hospital for special surgery knee score (HSS), the Western Ontario and McMaster Universities (WOMAC) index, the Short Form 12 (SF‐12) health survey, visual analogue scale score, and radiographic assessment with a mean follow‐up of 6.4 years. Paired t‐tests were used to determine the significance of changes in clinical scores and knee mobility.ResultsA mean follow‐up of 77.2 (±17.6, standard deviation [SD]) months was performed, and none of the patients underwent knee revision for infection or aseptic loosening. At the last follow‐up, the KSS knee score changed statistically from 37.1 (±19.7) preoperatively to 86.5 (±13.6, SD, p < 0.001) postoperatively and the KSS function score from 32.7 (±24.0) preoperatively to 78.3 (±15.6, SD, p < 0.001) postoperatively. The knee mobility improved from a mean of preoperative 72.61° (±33.42°, SD) to 108.52° (±24.15°, SD, p < 0.001). Postoperative radiographs showed that the host bone was tightly integrated with the metaphyseal metal sleeve, and there was no obvious translucent line formation around the sleeve. Of the patients, 86.4% had a postoperative satisfaction score ≥8 (10‐point scale).ConclusionAt the mean follow‐up of 6.4 years, the survival rate of the metaphyseal sleeves was 100%. Metaphyseal sleeves combined with cementless stems is an excellent and viable option for reconstruction of AORI type II and type III bone defects of the knee.

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“…Small, isolated defects can be ixed with bone graft or cement; however, larger defects may necessitate bone grafting, metal augments with revision implants, tantalum cones and sleeves or revision prostheses [2]. The term "zonal fixation" refers to the necessity of achieving stable ixation in each of the three primary osseous zones: epiphysis, metaphysis, and diaphysis [48]. Porous tantalum structural cones have been developed to accomplish a proper structural and biomechanical repair of signiicant metaphyseal bone defects [47].…”

Section: Introductionmentioning

confidence: 99%

“…The term "zonal fixation" refers to the necessity of achieving stable fixation in each of the three primary osseous zones: epiphysis, metaphysis, and diaphysis [48]. Porous tantalum structural cones have been developed to accomplish a proper structural and biomechanical repair of significant metaphyseal bone defects [47].…”

Section: Introductionmentioning

confidence: 99%

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

Longo

Salvatore

Intermesoli

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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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.

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Zonal Fixation in Revision TKA: The Key Is Metaphyseal Fixation

Cited by 16 publications

References 37 publications

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

Imaging in revision total knee arthroplasty: A novel 3D classification system for tibial bone defects

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

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

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