Abstract
Introduction
Revision total knee arthroplasty with a cementless metaphyseal sleeve is suggested to be used without stem in revision total knee arthroplasty (rTKA). To the best of our knowledge, no papers investigating this have been published. The purpose of this study was to evaluate clinical outcome.
Method
In this retrospective study, 71 patients operated with rTKA with sleeves without stem in the period 2009–2011 were identified; 63 were examined. All patients with the prosthesis still in place were invited to a medical examination including X-rays. American Knee Society Score (AKSS) and Oxford Knee Score (OKS) were used as primary clinical outcome scores.
Results
Mean number of revisions including the revision with sleeve was 1.7. AKSS increased significantly from 62.7 to 109.6; (p value <0.0001). The overall satisfaction was 2.5 on a four-stage scale, going from very satisfied to dissatisfied (range 1–4). The Anderson Orthopaedic Research Institute (AORI) classification showed 63 % of the tibias and 56 % of the femurs to be type 2B, whereas 19 % tibias and 5 % femurs were type 3. Review of the X-rays showed all prostheses fixed. Mean tibiofemoral alignment was 6.0° valgus, and 51 % were outside optimal alignment (2.4°–7.2°). Six patients were excluded from the study.
Conclusions
We found that the prostheses were overall well fixed and patients’ AKSS increased significantly. Many patients had pain conditions, both comorbid pain and pain that might be alignment-related, and adding a stem thus seems to be a good idea in terms of alignment.
Level of evidence Level IV, case series without control group.
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References
Knæalloplastikregister D (2012) Dansk Knæalloplastikregister—Årsrapport 2012. Dansk Knæaaoplastikregister
Alexander GE, Bernasek TL, Crank RL, Haidukewych GJ (2013) Cementless metaphyseal sleeves used for large tibial defects in revision total knee arthroplasty. J Arthroplasty 28(4):604–607. doi:10.1016/j.arth.2012.08.006
Daines BK, Dennis DA (2013) Management of bone defects in revision total knee arthroplasty. Instr Course Lect 62:341–348
Engh GA, Ammeen DJ (1999) Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect 48:167–175
Haidukewych GJ, Hanssen A, Jones RD (2011) Metaphyseal fixation in revision total knee arthroplasty: indications and techniques. J Am Acad Orthop Surg 19(6):311–318
Jensen CL, Petersen MM, Schroder HM, Flivik G, Lund B (2012) Revision total knee arthroplasty with the use of trabecular metal cones: a randomized radiostereometric analysis with 2 years of follow-up. J arthroplasty 27(10):1820 e1822–1826 e1822. doi:10.1016/j.arth.2012.04.036
Dalury DF, Barrett WP (2016) The use of metaphyseal sleeves in revision total knee arthroplasty. Knee 23(3):545–548. doi:10.1016/j.knee.2016.02.005
Kamath AF, Lewallen DG, Hanssen AD (2015) Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. J Bone Jt Surg Am 97(3):216–223. doi:10.2106/JBJS.N.00540
Potter GD 3rd, Abdel MP, Lewallen DG, Hanssen AD (2016) Midterm results of porous tantalum femoral cones in revision total knee arthroplasty. J Bone Jt Surg Am 98(15):1286–1291. doi:10.2106/JBJS.15.00874
Bugler KE, Maheshwari R, Ahmed I, Brenkel IJ, Walmsley PJ (2015) metaphyseal sleeves for revision total knee arthroplasty: good short-term outcomes. J Arthroplasty 30(11):1990–1994. doi:10.1016/j.arth.2015.05.015
Graichen H, Scior W, Strauch M (2015) Direct, cementless, metaphyseal fixation in knee revision arthroplasty with sleeves-short-term results. J Arthroplasty 30(12):2256–2259. doi:10.1016/j.arth.2015.06.030
Barrack RL (2001) Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res 392:292–299
Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Jt Surg Brit 80(1):63–69
Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L (2000) Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 71(3):262–267. doi:10.1080/000164700317411852
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
Deehan DJ, Murray JD, Birdsall PD, Pinder IM (2006) Quality of life after knee revision arthroplasty. Acta Orthop 77(5):761–766. doi:10.1080/17453670610012953
Barton TM, White SP, Mintowt-Czyz W, Porteous AJ, Newman JH (2008) A comparison of patient based outcome following knee arthrodesis for failed total knee arthroplasty and revision knee arthroplasty. Knee 15(2):98–100. doi:10.1016/j.knee.2007.11.007
Clement ND, MacDonald D, Simpson AH (2014) The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(8):1933–1939. doi:10.1007/s00167-013-2776-5
Petterwood J, Dowsey MM, Rodda D, Choong PF (2014) The immediate post-operative radiograph is an unreliable measure of coronal plane alignment in total knee replacement. Front Surg 1:35. doi:10.3389/fsurg.2014.00035
Skytta ET, Lohman M, Tallroth K, Remes V (2009) Comparison of standard anteroposterior knee and hip-to-ankle radiographs in determining the lower limb and implant alignment after total knee arthroplasty. Scand J Surg 98(4):250–253
Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24(6 Suppl):39–43. doi:10.1016/j.arth.2009.04.034
Acknowledgments
We thank Anne Hjelm, secretary in the DKR, and senior consultant, president of DKR, Anders Odgaard for help with gaining the preoperative data.
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Gøttsche, D., Lind, T., Christiansen, T. et al. Cementless metaphyseal sleeves without stem in revision total knee arthroplasty. Arch Orthop Trauma Surg 136, 1761–1766 (2016). https://doi.org/10.1007/s00402-016-2583-9
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DOI: https://doi.org/10.1007/s00402-016-2583-9