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Metaphyseal sleeves in total knee arthroplasty revision: complications, clinical and radiological results. A systematic review of the literature

  • Knee Revision Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Total knee arthroplasty revision (TKAr) is increasing of relevance in orthopaedic surgeon daily practice and will become more and more relevant in the future. The aim of this study is to summarize indications, complications, clinical and radiological mid-term results of metaphyseal sleeves in management of bone defects in TKAr.

Methods

A systematic review of English literature was performed on Medline. Retrospective or prospective studies with 2 years of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Rates of intraoperative fractures, aseptic loosening, periprosthetic joint infection (PJI), reoperations and re-revisions were extrapolated by the papers.

Results

13 articles with a level of evidence of IV were included in the systematic review. 1079 TKAr (1554 sleeves) with a mean FU of 4.0 ± 1.1 years were analysed. The studies showed good clinical and functional outcomes. Sleeves allowed a stable metaphyseal fixation and osseointegration with an implant and sleeves aseptic survival rate of 97.7 and 99.2%, respectively. The incidence of PJI was 2.7 ± 2.4%. The estimated rate of reoperations and re-revisions were 14.2 ± 9.2 and 7.1 ± 4.8%, respectively.

Conclusion

Metaphyseal sleeves represent a viable option in management of types IIb and III AORI bone defects in TKAr. Further high-quality log-term studies would better clarify complications, clinical and radiological results of this promising technique in total knee arthroplasty revision.

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References

  1. Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780

    PubMed  Google Scholar 

  2. National Joint Registry for England, Wales and Northern Ireland (2015) 13th Annual Report 2015

  3. Mancuso F, Beltrame A, Colombo E et al. (2017) Management of metaphyseal bone loss in revision knee arthroplasty. Acta Biomed 88(2-S): 98–111

    PubMed  Google Scholar 

  4. Chalmers BP, Desy NM, Pagnano MW, Trousdale RT, Taunton MJ (2017) Survivorship metaphyseal sleeves in revision total knee arthroplasty. J Arthroplasty 32(5):1565–1570

    Article  PubMed  Google Scholar 

  5. Dalury DF, Barrett WP (2016) The use of metaphyseal sleeves in revision total knee arthroplasty. Knee 23(3):545–548

    Article  PubMed  Google Scholar 

  6. Alexander GE, Bernasek TL, Crank RL, Haidukewych GJ (2013) Cementless metaphyseal sleeves used for large tibial defects in revision total knee arthroplasty. J Arthroplasty Apr 28(4):604–607

    Article  PubMed  Google Scholar 

  7. Huang R, Barrazueta G, Ong A, Orozco F, Jafari M, Coyle C, Austin M (2014) Revision total knee arthroplasty using metaphyseal sleeves at short-term follow-up. Orthopedics Sep 37(9):e804-9

    Google Scholar 

  8. OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Oxford Center for Evidence-Based Medicine. May 2016. http://www.cebm.net/index.aspx?o=5653. Accessed Aug 2017

  9. Agarwal S, Azam A, Morgan-Jones R (2013) Metal metaphyseal sleeves in revision total knee replacement. Bone Joint J 95-B(12):1640–1644

    Article  PubMed  CAS  Google Scholar 

  10. Barnett SL, Mayer RR, Gondusky JS, Choi L, Patel JJ, Gorab RS (2014) Use of stepped porous titanium metaphyseal sleeves for tibial defects in revision total knee arthroplasty: short term results. J Arthroplasty Jun 29(6):1219–1224

    Article  PubMed  Google Scholar 

  11. Bugler KE, Maheshwari R, Ahmed I, Brenkel IJ, Walmsley PJ (2015) Metaphyseal sleeves for revision total knee arthroplasty: good short-term outcomes. Arthroplasty 30(11):1990–1994

    Article  Google Scholar 

  12. Fedorka CJ, Chen AF, Pagnotto MR, Crossett LS, Klatt BA (2017) Revision total knee arthroplasty with porous-coated metaphyseal sleeves provides radiographic ingrowth and stable fixation. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4493-y (epub ahead of print)

    Article  PubMed  Google Scholar 

  13. Gøttsche D, Lind T, Christiansen T, Schrøder HM (2016) Cementless metaphyseal sleeves without stem in revision total knee arthroplasty. Arch Orthop Trauma Surg 136(12):1761–1766

    Article  PubMed  Google Scholar 

  14. Graichen H, Scior W, Strauch M (2015) Direct, cementless, metaphyseal fixation in knee revision arthroplasty with sleeves-short-term results. J Arthroplasty 30(12):2256–2259

    Article  PubMed  Google Scholar 

  15. Jones RE, Barrack RL, Skedros J (2001) Modular, mobile-bearing hinge total knee arthroplasty. Clin Orthop Relat Res Nov;(392):306–314

  16. Martin-Hernandez C, Floria-Arnal LJ, Muniesa-Herrero MP et al (2017) Mid-term results for metaphyseal sleeves in revision knee surgery. Knee Surg Sports Traumatol Arthrosc 25(12):3779–3785

    Article  PubMed  Google Scholar 

  17. Watters TS, Martin JR, Levy DL, Yang CC, Kim RH, Dennis DA (2017) Porous-Coated Metaphyseal Sleeves for Severe Femoral and Tibial Bone Loss in Revision TKA. J Arthroplasty S0883-5403(17):3468–3473

    Article  Google Scholar 

  18. Engh GA, Parks NL (1997) The management of bone defects in revision total knee arthroplasty. Insta Course Lect 46:227–236

    CAS  Google Scholar 

  19. Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 257:107e28

    Google Scholar 

  20. Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Google Scholar 

  21. Formica M, Cavagnaro L, Basso M, Zanirato A, Palermo A, Felli L (2017) What is the fate of the neck after a collum femoris preserving prosthesis? A nineteen years single center experience. Int Orthop 41(7):1329–1335

    Article  PubMed  Google Scholar 

  22. Sanguineti F, Mangano T, Formica M, Franchin F (2014) Total knee arthroplasty with rotating-hinge endo-model prosthesis: clinical results in complex primary and revision surgery. Arch Orthop Trauma Surg 134(11):1601–1607

    Article  PubMed  CAS  Google Scholar 

  23. Cavagnaro L, Formica M, Basso M, Zanirato A, Divano S, Felli L (2017) Femoral revision with primary cementless stems: a systematic review of the literature. Musculoskelet Surg 102(1):1–9

    Google Scholar 

  24. Morgan-Jones R, Oussedik S, Graichen H, Haddad F (2015) A zonal fixation classification in revision total knee arthroplasty: a methodology to aid reconstruction, fixation and implant survival. Bone Joint J (accepted for publication)

  25. Fehring TK, Odum S, Olekson C et al (2003) Stem fixation in revision total knee arthroplasty: a comparative analysis. Clin Orthop Relat Res 416:217

    Article  Google Scholar 

  26. Lonner JH, Klotz M, Levitz C et al (2001) Changes in bone density after cemented total knee arthroplasty: influence of stem design. J Arthroplasty 16:107

    Article  PubMed  CAS  Google Scholar 

  27. Barrack RL, Rorabeck C, Burt M et al (1999) Pain at the end of the stem after revision total knee arthroplasty. Clin Orthop Relat Res 367:216

    Article  Google Scholar 

  28. Barrack RL, Stanley T, Burt M et al (2004) The effect of stem design on end-of stem pain in revision total knee arthroplasty. J Arthroplasty 19:119

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy

    Andrea Zanirato, Luca Cavagnaro, Marco Basso, Stefano Divano, Lamberto Felli & Matteo Formica

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  1. Andrea Zanirato
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  2. Luca Cavagnaro
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  3. Marco Basso
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  4. Stefano Divano
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  5. Lamberto Felli
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  6. Matteo Formica
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Correspondence to Andrea Zanirato.

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Zanirato, A., Cavagnaro, L., Basso, M. et al. Metaphyseal sleeves in total knee arthroplasty revision: complications, clinical and radiological results. A systematic review of the literature. Arch Orthop Trauma Surg 138, 993–1001 (2018). https://doi.org/10.1007/s00402-018-2967-0

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  • DOI: https://doi.org/10.1007/s00402-018-2967-0

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