Mid-term clinical and radiographic outcomes of porous-coated metaphyseal sleeves used in revision total knee arthroplasty

Abstract

Background: The management of bone defects remains one of the major challenges surgeons are faced with in revision total knee arthroplasty (RTKA). Large and uncontained bone defects are traditionally managed with metaphyseal sleeves that facilitate osseointegration and have reported construct stability. While many studies have presented excellent short-term outcomes using metaphyseal sleeves, less is known on their performance in the longer term. The purpose of this study was to present our mid-term results of the metaphyseal sleeves used in patients undergoing RTKA.

Materials and methods: Between January 2007 and January 2015, 30 patients underwent RTKA with the use of a CCKMB prosthesis combined with an osteointegrative sleeve. The main indications for RTKA were instability in 40% of the cases (n = 12), aseptic loosening in 30% (n = 9), infection in 26.7% (n = 8), and "other" in 3.3% (n = 1). The minimal follow-up time was 5 years and the mean follow-up time was 82.4 months (SD = 22.6). Clinical outcomes were assessed by Knee Society scores (KSS), range of motion and rate of re-operation.

Results: The mean Knee Society score increased significantly from 72.1 preoperatively to 90.0 postoperatively (p < 0.001). The cumulative incidence of re-operation in our study was 13.3% (n = 4). Our study reported no cases of aseptic loosening or mobile-bearing spin-out. Knee flexion to 90° and more was impossible in seven cases (23.3%) preoperatively and in one case (3.3%) postoperatively.

Conclusion: Porous-coated metaphyseal sleeves demonstrated excellent rates of survivorship and radiographic ingrowth in the mid-term setting. However, further studies are required to assess their outcomes in the long-term.

Keywords: Bone loss; Metaphyseal sleeve; Revision total knee arthroplasty.

Fig. 1

Antero-posterior (AP) and lateral view of the right knee of a 68-year old patient who underwent a second-stage revision total knee arthroplasty. A non-progressive radiolucent line of 1–2 mm around the stem, the anterior part of the femoral sleeve and the tibial plate are seen in radiographs taken 7 years postoperatively. Clinically, the patient had no signs of loosening