Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Oct 11;7(1):19-24.
doi: 10.1055/s-0039-1697611. eCollection 2019 Mar.

Are Metaphyseal Sleeves a Viable Option to Treat Bone Defect during Revision Total Knee Arthroplasty? A Systematic Review

Tommaso Bonanzinga  1 , Ibrahim Akkawi  2 , Akos Zahar  3 , Thorsten Gehrke  3 , Carl Haasper  3 , Maurilio Marcacci  1
Affiliations
Review

Are Metaphyseal Sleeves a Viable Option to Treat Bone Defect during Revision Total Knee Arthroplasty? A Systematic Review

Tommaso Bonanzinga et al. Joints. .

Abstract

Purpose Bone loss is a challenging problem during revision total knee arthroplasty (TKA). Several studies have been published on the use of metaphyseal sleeves during revision TKA. Therefore, the aim of this systematic review was to summarize the clinical and radiographic outcomes of the use of metaphyseal sleeves in the setting of revision TKA. Methods A comprehensive search of PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar was performed, covering the period between January 1, 2000, and August 12, 2017. Various combinations of the following key words were used: "metaphyseal," "sleeves," "knee," and "revision." A total of 10 studies were included in the present systematic review. Results A total of 904 patients with 928 implants were recorded with a mean age of 69 years. They were evaluated at a mean follow-up of 45 months. Overall 1,413 sleeves, 888 in the tibia and 525 in the femur, were implanted. There were 36 septic re-revisions of the prosthetic components (4%). Five sleeves were found loose during septic re-revision; therefore, the rate of septic loosening of the sleeves was 0.35%. An aseptic re-revision of the prosthetic components was performed 27 times (3%). Ten sleeves were found loose during aseptic re-revision; therefore, the rate of aseptic loosening of the sleeves was 0.7%. Intraoperative fractures occurred 44 times (3.1%). Finally, clinical outcome was improved at final follow-up. Conclusion Metaphyseal sleeves demonstrate high radiographic signs of osteointegration, low septic loosening rate, low intraoperative fractures rate, and a good-to-excellent clinical outcome. Hence, they are a valid option to treat large metaphyseal bone defect during revision TKA. Level of Evidence This is a systematic review of level IV studies.

Keywords: AORI; bone defect; metaphyseal sleeves; revision total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
The quality of reporting of meta-analyses flow diagram of included studies. Studies identified, included, and excluded as well as the reasons for exclusion. TKA, total knee arthroplasty.
See this image and copyright information in PMC

References

    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(04):780–785. - PubMed
    1. Radnay C S, Scuderi G R. Management of bone loss: augments, cones, offset stems. Clin Orthop Relat Res. 2006;446(446):83–92. - PubMed
    1. Vasso M, Beaufils P, Cerciello S, Schiavone Panni A. Bone loss following knee arthroplasty: potential treatment options. Arch Orthop Trauma Surg. 2014;134(04):543–553. - PubMed
    1. Haidukewych G J, Hanssen A, Jones R D. Metaphyseal fixation in revision total knee arthroplasty: indications and techniques. J Am Acad Orthop Surg. 2011;19(06):311–318. - PubMed
    1. Ponzio D Y, Austin M S. Metaphyseal bone loss in revision knee arthroplasty. Curr Rev Musculoskelet Med. 2015;8(04):361–367. - PMC - PubMed