Porous-Coated Metaphyseal Sleeves for Severe Femoral and Tibial Bone Loss in Revision TKA

• Published in: The Journal of arthroplasty 2017-11, Vol.32 (11), p.3468-3473
• Main Authors: Watters, Tyler Steven, MD, Martin, J. Ryan, MD, Levy, Daniel L., BS, Yang, Charlie C., MD, Kim, Raymond H., MD, Dennis, Douglas A., MD
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Knee - instrumentation; Arthroplasty, Replacement, Knee - methods; bone loss; Female; Femur - surgery; Humans; Knee Prosthesis; Male; metaphyseal fixation; metaphyseal sleeves; Middle Aged; Orthopedics; Prospective Studies; Prosthesis Design; Reoperation - instrumentation; Reoperation - methods; Retrospective Studies; revision techniques; revision total knee arthroplasty; Tibia - surgery
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.06.025

Abstract Background Metaphyseal bone loss is commonly encountered in revision total knee arthroplasty (TKA). Anderson Orthopaedic Research Institute (AORI) type 2 and 3 defects generally require some form of metaphyseal fixation or augmentation. This study evaluates the midterm results of stepped, porous-coated metaphyseal sleeves in revision TKA in the setting of severe bone loss. Methods Patients who underwent revision TKA using metaphyseal sleeves from March 2006 to May 2014 at our institution were identified from a prospective research database. Preoperative patient characteristics and operative data were reviewed. Postoperative outcomes were compared with preoperative values. Primary study outcomes included complications, reoperations, radiographic assessment of sleeve osteointegration, and survivorship. Results 116 knees (108 patients) underwent revision TKA with 152 metaphyseal sleeves (111 tibial, 41 femoral). AORI defect classification included five type 2A, 89 type 2B, and 17 type 3 tibial defects; and three type 2A, 34 type 2B, and four type 3 femoral defects. There were three intraoperative fractures (1.9%) associated with sleeve preparation/insertion. Six knees (5 patients) were lost-to-follow-up and five patients (6 knees) died before two years. Of the remaining 104 knees (98 patients, 134 sleeves), mean follow-up was 5.3 years (range 2 to 9.6 years). Nineteen knees (16.4%) required reoperation, most commonly for recurrent infection. Only one sleeve demonstrated radiographic evidence of failed osteointegration, but did not require revision. Two sleeves (1.5%) required removal/resection for recurrent infection. Conclusions This large retrospective series illustrates the utility of porous metaphyseal sleeves in revision TKA with a low rate of intraoperative complications, excellent osteointegration and long-term fixation.