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Mid-term results for metaphyseal sleeves in revision knee surgery

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Metaphyseal titanium sleeves have been used to provide cementless fixation in challenging bone defects in revision knee arthroplasty. The aim of this study was to evaluate the mid-term results of radiological and clinical outcomes, for metaphyseal sleeves in type 1B and 2 defects of tibia and femur under the hypothesis that they would provide stable and prolonged fixation.

Methods

One hundred and thirty-four patients were included in a prospective study to evaluate the outcomes of knee revision with sleeves, together with stems and varus–valgus constrained mobile bearing prosthesis. Median follow-up was 71.5 months (range 36–107). Analysis included American Knee Society Score (KSS), Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), SF12 Health Survey and radiographic assessment.

Results

All clinical scores improved significantly in all patients during the follow-up. The median of Knee KSS increased from 33 to 78 and functional KSS from 30 to 80. The median of WOMAC pain index changed from 12 to 4; pre-operative median of WOMAC stiffness and WOMAC function score improved from 5 to 2 and from 45 to 14, respectively. The median of physical SF12 varied from 27 to 44, while mental SF-12 from 43 to 54. Radiological evaluation showed optimal osseous integration in all patients, and neither implant migration nor progressive radiolucency around components was observed. Complications included three cases of end-of-stem pain at tibial side and two revisions due to septic loosening in the first post-operative year. No aseptic loosening was reported.

Conclusion

The use of metaphyseal sleeves, in combination with uncemented stems and varus–valgus constrained components with rotating platform, has shown excellent mid-term results allowing osseous ingrowth with no evidence of osteolysis or displacement. This is a promising option for better implant fixation in revision TKA.

Level of evidence

Case series with no comparison group, Level IV.

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Authors and Affiliations

  1. Hospital Universitario Miguel Servet, Aragon Institute for Health Research (IIS Aragon), Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain

    Carlos Martin-Hernandez

  2. Hospital Obispo Polanco, Avda Ruiz Jarabo S/N, 44002, Teruel, Spain

    Luis Javier Floria-Arnal, Maria Pilar Muniesa-Herrero, Teresa Espallargas-Doñate, Jose Adolfo Blanco-Llorca, Melchor Guillen-Soriano & Miguel Ranera-Garcia

Authors
  1. Carlos Martin-Hernandez
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  2. Luis Javier Floria-Arnal
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  3. Maria Pilar Muniesa-Herrero
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  4. Teresa Espallargas-Doñate
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  5. Jose Adolfo Blanco-Llorca
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  6. Melchor Guillen-Soriano
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  7. Miguel Ranera-Garcia
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Corresponding author

Correspondence to Carlos Martin-Hernandez.

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Conflict of interest

Carlos Martin-Hernandez has received speaker honorarium from DePuy Synthes, Luis Javier Floria-Arnal, Maria Pilar Muniesa-Herrero, Teresa Espallargas-Doñate, Jose Adolfo Blanco-Llorca, Melchor Guillen-Soriano, and Miguel Ranera-Garcia declare that they have no conflict of interest.

Funding

This study received no funding.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional ethical committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Martin-Hernandez, C., Floria-Arnal, L.J., Muniesa-Herrero, M.P. et al. Mid-term results for metaphyseal sleeves in revision knee surgery. Knee Surg Sports Traumatol Arthrosc 25, 3779–3785 (2017). https://doi.org/10.1007/s00167-016-4298-4

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  • DOI: https://doi.org/10.1007/s00167-016-4298-4

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