Abstract
Revision total knee arthroplasty implant design has shifted away from structural allograft and long diaphyseal engaging stems toward more proximal fixation. The use of tibial sleeves and cones has decreased the complications associated with the prior generation of implants, while having low rates of aseptic loosening (<3% at midterm follow-up). The use of sleeves or cones allows for bone loss to be addressed with concurrent full weight bearing postoperatively. However, each system has its own nuances with which the surgeon should be well acquainted. Care should be taken when broaching or reaming to avoid intraoperative fractures, and if long stems are required, a slotted design is recommended to prevent end-of-stem pain. Although long-term results remain forthcoming, the positive midterm data of sleeves and cones compared to structural allograft or diaphyseal fixation make them an option for every surgeon’s revision knee armamentarium.
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Pivec, R., Austin, M.S. (2022). Metaphyseal Fixation: Sleeves and Cones. In: Hansen, E., Kühn, KD. (eds) Essentials of Cemented Knee Arthroplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-63113-3_64
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