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. 2021 Sep;50(9):750-757.
doi: 10.1007/s00132-020-04008-1.

Metaphyseal sleeves in arthroplasty of the knee : A suitable tool in management of major metaphyseal bone loss

Christian Lycke  1 , Dirk Zajonz  2 , Alexander Brand  3 , Torsten Prietzel  2 , Christoph-E Heyde  3 , Andreas Roth  3 , Mohamed Ghanem  3
Affiliations

Metaphyseal sleeves in arthroplasty of the knee : A suitable tool in management of major metaphyseal bone loss

Christian Lycke et al. Orthopade. 2021 Sep.

Abstract
in English, German

Background: This study examined the clinical outcome following revision arthroplasty of the knee joint and severe arthrosis with metaphyseal bone defects and instability using metaphyseal sleeves. We analyzed the results based on established scores and recorded the complications occurring on revision arthroplasty.

Material and methods: Patients with revision arthroplasty of the knee and metaphyseal bone defects grade III according to the Anderson Orthopedic Research Institute (AORI) classification were included (16 patients, 9 females and 7 males). In all cases, surgery was performed using an endoprosthesis COMPLETE™ revision knee system with metaphyseal sleeves.

Results: All patients had a significant reduction in pain level after revision surgery. The median HSS score in the cohort with primary arthroplasty was 84 and in the cohort with revision arthroplasty 73 and the KSS was 83 and 55, respectively. According to the HSS an excellent result was achieved by 50% of the patients in the primary arthroplasty group and 25% in the revision group. Only three patients were considered to have an insufficient result. Postoperative pain was significantly reduced in both groups. The median ROM was 112° flexion in the primary arthroplasty group and 95° in the revision group. An extension deficit was observed in three patients and four patients showed prolonged wound healing postoperatively (25%), which was treated conservatively and did not lead to septic changes.

Conclusion: The use of metaphyseal sleeves in patients with bone defects is a suitable instrument with no negative impact on the outcome both in primary and revision arthroplasty. Further studies with larger study groups and analysis of long-term results after use of such endoprosthetic components should be conducted.

Zusammenfassung: HINTERGRUND: Diese Arbeit untersucht das klinische Ergebnis nach Verwendung sog. Sleeves (Hülsen) in der aseptischen Revisionsendoprothetik des Kniegelenks sowie bei schwerster Arthrose mit metaphysären Knochendefekten und Instabilität. Die Ergebnisse wurden auf der Grundlage etablierter Scores analysiert und die aufgetretenen Komplikationen erfasst.

Material und methoden: Es wurden Patienten mit Revisionsendoprothesen des Knies und metaphysären Knochendefekten mit einem Klassifizierungsgrad III nach dem Anderson Orthopedic Research Institute (AORI) eingeschlossen (16 Patienten; 9 weiblich und 7 männlich). In allen Fällen wurde die Operation mit dem Endoprothesen-Revisionssystem COMPLETE™ mit metaphysären Sleeves durchgeführt.

Ergebnisse: Bei allen Patienten konnte eine signifikante Reduktion der Schmerzen durch die Revisionsoperation erzielt werden. Der Medianwert des HSS-Scores lag bei 84 in der Gruppe der primär Operierten und bei 73 in der Gruppe mit Voroperationen, der Wert des KSS-Scores betrug 83 bzw. 55. Entsprechend des HSS-Scores erhielten 50 % der Patientengruppe der Erstoperierten ein „ausgezeichnetes“ Ergebnis und 25 % in der Revisionsgruppe. Nur 3 Patienten wurden insgesamt als „unzureichend“ eingestuft. Die postoperativen Schmerzen waren im Vergleich zu den präoperativen in beiden Gruppen signifikant reduziert. Der mediane Bewegungsumfang (ROM) betrug 112° Beugung in der primär operierten Gruppe bzw. 95° in der Revisionsgruppe. Bei 3 Patienten wurde ein Extensionsdefizit beobachtet und 4 Patienten zeigten postoperativ eine prolongierte Wundheilung (25 %), die konservativ behandelt wurde und nicht zu septischen Revisionseingriffen führte.

Schlussfolgerung: Metaphysären Sleeves stellen bei Patienten mit Knochendefekten ein geeignetes Instrument dar, das sowohl bei Primäreingriffen als auch bei Revisionsoperationen nicht zu unterlegenen Ergebnissen bei Patienten mit schweren metaphysären knöchernen Defekten führt. Weitere Studien mit größeren Studiengruppen und die Analyse der Langzeitergebnisse nach dem Einsatz solcher endoprothetischer Komponenten sollten durchgeführt werden.

Keywords: Aseptic loosening; Complications; Osteoarthritis, knee; Retrospective study; Revision arthroplasty.

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Conflict of interest statement

C. Lycke, D. Zajonz, A. Brand, T. Prietzel, C.-E. Heyde, A. Roth and M. Ghanem declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
X‑ray radiographs (a anteroposterior and d lateral view) of a patient with aseptic KTEP loosening and simultaneous tibial and femoral periprosthetic fractures with metaphyseal bone loss after explantation of the primary components. Significant osteoporosis was identified during surgery (courtesy of the Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, all rights reserved). c, d The same patient (c anteroposterior, b lateral view) after removal of the loosened total knee components and implantation of a rotating hinge knee revision system with metaphyseal sleeves (courtesy of the Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, all rights reserved)
Fig. 2
Fig. 2
X‑ray radiographs (a anteroposterior, b lateral view) of aseptic loosening of primary total knee components with major osteolytic changes in the proximal tibial diaphysis due to wear of the inlay (particle disease) (courtesy of the Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, all rights reserved). c, d Prior to surgery (c anteroposterior, d lateral view) a CT scan was performed to confirm the diagnosis and rule out malignant transformation (courtesy of the Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, all rights reserved). e, f The same patient (e anteroposterior, f lateral view) after implantation of a rotating hinge knee revision system with metaphyseal sleeves (courtesy of the Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, all rights reserved)
Fig. 3
Fig. 3
Overview of the patient selection process. Out of a total of 685 patients, 12 patients met the inclusion criteria, 4 patients with primary implants were additionally included TKA total knee arthroplasty, AORI Anderson Orthopedic Research Institute. All patients with primary surgery had the most severe grade IV arthrosis after Kellgren and Lawrence classification[17]
Fig. 4
Fig. 4
Overview of preoperative and postoperative pain levels using the numerical rating scale (NRS). Pain reduction was significant (p < 0.001): median preoperative pain level was 7.7/10 (±1.4) shown on the left side, median postoperative pain level was 2.7/10 (±1.9) on the NRS shown on the right side. The Asterisk represent the statistical outliers
See this image and copyright information in PMC

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References

    1. Agarwal S, Azam A, Morgan-Jones R. Metal metaphyseal sleeves in revision total knee replacement. Bone Joint J. 2013;95-B(12):1640–1644. doi: 10.1302/0301-620X.95B12.31190. - DOI - PubMed
    1. Alexander GE, Bernasek TL, Crank RL, Haidukewych GJ. Cementless metaphyseal sleeves used for large tibial defects in revision total knee arthroplasty. J Arthroplasty. 2013;28(4):604–607. doi: 10.1016/j.arth.2012.08.006. - DOI - PubMed
    1. Angerame MR, Jennings JM, Holst DC, Dennis DA. Management of bone defects in revision total knee arthroplasty with use of a stepped, porous-coated metaphyseal sleeve. JBJS Essent Surg Tech. 2019;9(2):e14. doi: 10.2106/JBJS.ST.18.00038. - DOI - PMC - PubMed
    1. Barnett SL, Mayer RR, Gondusky JS, Choi L, Patel JJ, Gorab RS. Use of stepped porous titanium metaphyseal sleeves for tibial defects in revision total knee arthroplasty: short term results. J Arthroplasty. 2014;29(6):1219–1224. doi: 10.1016/j.arth.2013.12.026. - DOI - PubMed
    1. Bonanzinga T, Akkawi I, Zahar A, Gehrke T, Haasper C, Marcacci M. Are Metaphyseal sleeves a viable option to treat bone defect during revision total knee arthroplasty? A systematic review. Joints. 2019;7(1):19–24. doi: 10.1055/s-0039-1697611. - DOI - PMC - PubMed