Skip to main content
SpringerLink
Log in

Metaphyseal cones and sleeves in revision total knee arthroplasty: Two sides of the same coin? Complications, clinical and radiological results—a systematic review of the literature

  • Review
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Revision total knee arthroplasty (rTKA) is increasing of relevance in orthopaedic surgeon daily practice and this trend is likely to continue in the years ahead. The aim of this systematic review of English literature is to summarize and compare indications, complications, clinical and radiological results of metaphyseal cones and sleeves in management of bone loss in rTKA. Retrospective or prospective studies with at least 1 year of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Clinical and radiological results, rates of intraoperative fractures, aseptic loosening, periprosthetic joint infection, septic failure, reoperations and re-revisions were extrapolated by the papers. Thirty-seven articles were included in the systematic review. Results of 927 cones (mean FU of 3.6 ± 1.4 years) and 1801 sleeves (mean FU of 4.5 ± 1.6 years) were analysed. The studies showed good clinical and functional outcomes. Cones and sleeves allowed a stable metaphyseal fixation. The aseptic survivorship of the implants was 97.3% in cones group and 97.8% in sleeves group. Metaphyseal cones and sleeves represent a viable option in management of type IIb and III AORI bone defects in aseptic and septic TKAr with overlapping survival rate. Further high-quality long-term studies would better clarify complications, clinical and radiological results of these promising techniques in revision total knee arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am 89(4):780

    Google Scholar 

  2. Morgan-Jones R, Oussedik S, Graichen H, Haddad F (2015) Zonal fixation in revision total knee arthroplasty. Bone Jt J 97-B:147–149

    CAS  Google Scholar 

  3. Ponzio DY, Austin MS (2015) Metaphyseal bone loss in revision knee arthroplasty. Curr Rev Musculoskelet Med 8(4):361–367

    PubMed  PubMed Central  Google Scholar 

  4. Engh GA, Parks NL (1997) The management of bone defects in revision total knee arthroplasty. Insta Course Lect 46:227–236

    CAS  Google Scholar 

  5. Mancuso F, Beltrame A, Colombo E et al (2017) Management of metaphyseal bone loss in revision knee arthroplasty. Acta Biomed 88(2-S):98–111

    PubMed  PubMed Central  Google Scholar 

  6. Sheth NP, Bonadio MB, Demange MK (2017) Bone loss in revision total knee arthroplasty: evaluation and management. J Am Acad Orthop Surg 25(5):348–357

    PubMed  Google Scholar 

  7. Lachiewicz PF, Bolognesi MP, Henderson RA, Soileau ES, Vail TP (2012) Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res 470(1):199–204

    PubMed  Google Scholar 

  8. Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF (2007) Rotating hinged total knee replacement: use with caution. J Bone Jt Surg Am 89(8):1735–1741

    Google Scholar 

  9. Kostuj T, Streit R, Baums MH, Schaper K, Meurer A (2015) Midterm outcome after mega-prosthesis implanted in patients with bony defects in cases of revision compared to patients with malignant tumors. J Arthroplasty 30(9):1592–1596

    PubMed  Google Scholar 

  10. Divano S, Cavagnaro L, Zanirato A, Basso M, Felli L, Formica M (2018) Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature. Arch Orthop Trauma Surg 138(6):851–863

    PubMed  Google Scholar 

  11. Bonanzinga T, Gehrke T, Zahar A, Zaffagnini S, Marcacci M, Haasper C (2017) Are trabecular metal cones a valid option to treat metaphyseal bone defects in complex primary and revision knee arthroplasty? Joints 6(1):58–64

    PubMed  PubMed Central  Google Scholar 

  12. Zanirato A, Cavagnaro L, Basso M, Divano S, Felli L, Formica M (2018) Metaphyseal sleeves in total knee arthroplasty revision: complications, clinical and radiological results. A systematic review of the literature. Arch Orthop Trauma Surg 138(7):993–1001

    PubMed  Google Scholar 

  13. OCEBM Levels of Evidence Working Group (2016) The Oxford levels of evidence 2. Oxford center for evidence-based medicine. http://www.cebm.net/index.aspx?o=5653. Accessed Aug 2018

  14. Bohl DD, Brown NM, McDowell MA, Levine BR, Sporer SM, Paprosky WG, Della Valle CJ (2018) Do porous tantalum metaphyseal cones improve outcomes in revision total knee arthroplasty? J Arthroplasty 33(1):171–177

    PubMed  Google Scholar 

  15. Boureau F, Putman S, Arnould A, Dereudre G, Migaud H, Pasquier G (2015) Tantalum cones and bone defects in revision total knee arthroplasty. Orthop Traumatol Surg Res 101(2):251–255

    CAS  PubMed  Google Scholar 

  16. Brown NM, Bell JA, Jung EK, Sporer SM, Paprosky WG, Levine BR (2015) The use of trabecular metal cones in complex primary and revision total knee arthroplasty. J Arthroplasty 30(9 Suppl):90–93

    PubMed  Google Scholar 

  17. Burastero G, Cavagnaro L, Chiarlone F, Alessio-Mazzola M, Carrega G, Felli L (2018) The use of tantalum metaphyseal cones for the management of severe bone defects in septic knee revision. J Arthroplasty 33(12):3739–3745. https://doi.org/10.1016/j.arth.2018.08.026

    Article  PubMed  Google Scholar 

  18. De Martino I, De Santis V, Sculco PK, D’Apolito R, Assini JB, Gasparini G (2015) Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res 473(10):3176–3182

    PubMed  PubMed Central  Google Scholar 

  19. Derome P, Sternheim A, Backstein D, Malo M (2014) Treatment of large bone defects with trabecular metal cones in revision total knee arthroplasty: short term clinical and radiographic outcomes. J Arthroplasty 29(1):122–126

    PubMed  Google Scholar 

  20. Fosco M, Amendola L, Fantasia R et al (2013) Revision total knee arthroplasty: experience with tantalum cones in severe bone loss. Eur Orthop Traumatol 4:131–136. https://doi.org/10.1007/s12570-013-0160-z

    Article  Google Scholar 

  21. Girerd D, Parratte S, Lunebourg A, Boureau F, Ollivier M, Pasquier G, Putman S, Migaud H, Argenson JN (2016) Total knee arthroplasty revision with trabecular tantalum cones: preliminary retrospective study of 51 patients from two centres with a minimal 2-year follow-up. Orthop Traumatol Surg Res 102(4):429–433

    CAS  PubMed  Google Scholar 

  22. Howard JL, Kudera J, Lewallen DG, Hanssen AD (2011) Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Jt Surg Am 93(5):478–484

    Google Scholar 

  23. Jensen CL, Winther N, Schrøder HM, Petersen MM (2014) Outcome of revision total knee arthroplasty with the use of trabecular metal cone for reconstruction of severe bone loss at the proximal tibia. Knee 21(6):1233–1237

    PubMed  Google Scholar 

  24. 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

    Google Scholar 

  25. Long WJ, Scuderi GR (2009) Porous tantalum cones for large metaphyseal tibial defects in revision total knee arthroplasty: a minimum 2-year follow-up. J Arthroplasty 24(7):1086–1092

    PubMed  Google Scholar 

  26. Meneghini RM, Lewallen DG, Hanssen AD (2008) Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Jt Surg Am 90(1):78–84

    Google Scholar 

  27. Mozella Ade P, Olivero RR, Alexandre H, Cobra AB (2014) Use of a trabecular metal cone made of tantalum, to treat bone defects during revision knee arthroplasty. Rev Bras Ortop 49(3):245–251

    PubMed  Google Scholar 

  28. 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

    Google Scholar 

  29. Rajgopal A, Panda I, Yadav S, Wakde O (2018) Stacked tantalum cones as a method for treating severe distal femoral bone deficiency in total knee arthroplasty. J Knee Surg. https://doi.org/10.1055/s-0038-1669789

    Article  PubMed  Google Scholar 

  30. Rao BM, Kamal TT, Vafaye J, Moss M (2013) Tantalum cones for major osteolysis in revision knee replacement. Bone Jt J 95-B(8):1069–1074

    CAS  Google Scholar 

  31. Sandiford NA, Misur P, Garbuz DS, Greidanus NV, Masri BA (2017) No difference between trabecular metal cones and femoral head allografts in revision TKA: minimum 5-year followup. Clin Orthop Relat Res 475(1):118–124

    PubMed  Google Scholar 

  32. Schmitz HC, Klauser W, Citak M, Al-Khateeb H, Gehrke T, Kendoff D (2013) Three-year follow up utilizing tantal cones in revision total knee arthroplasty. J Arthroplasty 28(9):1556–1560

    PubMed  Google Scholar 

  33. Villanueva-Martínez M, De la Torre-Escudero B, Rojo-Manaute JM, Ríos-Luna A, Chana-Rodriguez F (2013) Tantalum cones in revision total knee arthroplasty. A promising short-term result with 29 cones in 21 patients. J Arthroplasty 28(6):988–993

    PubMed  Google Scholar 

  34. Agarwal S, Neogi DS, Morgan-Jones R (2018) Metaphyseal sleeves in revision total knee arthroplasty: minimum seven-year follow-up study. Knee 25:1299–1307. https://doi.org/10.1016/j.knee.2018.09.010

    Article  PubMed  Google Scholar 

  35. 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

    PubMed  Google Scholar 

  36. Barnett SL, Mayer RR, Gondusky JS, Choi L, Patel JJ, Gorab RS (2014) Use of stepped porous titanium metaphyseal sleeves for tibial defects in revision total knee arthroplasty: short term results. J Arthroplasty 29(6):1219–1224

    PubMed  Google Scholar 

  37. Bugler KE, Maheshwari R, Ahmed I, Brenkel IJ, Walmsley PJ (2015) Metaphyseal sleeves for revision total knee arthroplasty: good short-term outcomes. Arthroplasty 30(11):1990–1994

    Google Scholar 

  38. Chalmers BP, Desy NM, Pagnano MW, Trousdale RT, Taunton MJ (2017) Survivorship metaphyseal sleeves in revision total knee arthroplasty. J Arthroplasty 32(5):1565–1570

    PubMed  Google Scholar 

  39. Dalury DF, Barrett WP (2016) The use of metaphyseal sleeves in revision total knee arthroplasty. Knee 23(3):545–548

    PubMed  Google Scholar 

  40. Fedorka CJ, Chen AF, Pagnotto MR, Crossett LS, Klatt BA (2018) Revision total knee arthroplasty with porous-coated metaphyseal sleeves provides radiographic ingrowth and stable fixation. Knee Surg Sports Traumatol Arthrosc 26(5):1500–1505

    PubMed  Google Scholar 

  41. Gøttsche D, Lind T, Christiansen T, Schrøder HM (2016) Cementless metaphyseal sleeves without stem in revision total knee arthroplasty. Arch Orthop Trauma Surg 136(12):1761–1766

    PubMed  Google Scholar 

  42. 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

    PubMed  Google Scholar 

  43. Huang R, Barrazueta G, Ong A, Orozco F, Jafari M, Coyle C, Austin M (2014) Revision total knee arthroplasty using metaphyseal sleeves at short-term follow-up. Orthopedics 37(9):e804–e809

    PubMed  Google Scholar 

  44. Jones RE, Barrack RL, Skedros J (2001) Modular, mobile-bearing hinge total knee arthroplasty. Clin Orthop Relat Res 392:306–314

    Google Scholar 

  45. Klim SM, Amerstorfer F, Bernhardt GA, Sadoghi P, Gruber G, Radl R, Leithner A, Glehr M (2018) Septic revision total knee arthroplasty: treatment of metaphyseal bone defects using metaphyseal sleeves. J Arthroplasty 33(12):3734–3738. https://doi.org/10.1016/j.arth.2018.08.017

    Article  PubMed  Google Scholar 

  46. Martin-Hernandez C, Floria-Arnal LJ, Muniesa-Herrero MP, Espallargas-Doñate T, Blanco-Llorca JA, Guillen-Soriano M, Ranera-Garcia M (2017) Mid-term results for metaphyseal sleeves in revision knee surgery. Knee Surg Sports Traumatol Arthrosc 25(12):3779–3785

    PubMed  Google Scholar 

  47. Stefani G, Mattiuzzo V, Prestini G (2017) Revision total knee arthroplasty with metaphyseal sleeves without stem: short-term results. Joints 5(4):207–211

    PubMed  PubMed Central  Google Scholar 

  48. Thorsell M, Hedström M, Wick MC, Weiss RJ (2018) Good clinical and radiographic outcome of cementless metal metaphyseal sleeves in total knee arthroplasty. Acta Orthop 89(1):84–88

    PubMed  Google Scholar 

  49. Watters TS, Martin JR, Levy DL, Yang CC, Kim RH, Dennis DA (2017) Porous-coated metaphyseal sleeves for severe femoral and tibial bone loss in revision TKA. J Arthroplasty S0883–5403(17):30536–30543

    Google Scholar 

  50. Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Google Scholar 

  51. Formica M, Cavagnaro L, Basso M, Zanirato A, Palermo A, Felli L (2017) What is the fate of the neck after a collum femoris preserving prosthesis? A nineteen years single center experience. Int Orthop 41(7):1329–1335

    PubMed  Google Scholar 

  52. Cavagnaro L, Formica M, Basso M, Zanirato A, Divano S, Felli L (2018) Femoral revision with primary cementless stems: a systematic review of the literature. Musculoskelet Surg 102(1):1–9

    PubMed  Google Scholar 

  53. Cottino U, Abdel MP, Perry KI, Mara KC, Lewallen DG, Hanssen AD (2017) Long-term results after total knee arthroplasty with contemporary rotating-hinge prostheses. J Bone Jt Surg Am 99(4):324–330

    Google Scholar 

  54. Agarwal S, Azam A, Morgan-Jones R (2013) Metal metaphyseal sleeves in revision total knee replacement. Bone Jt J 95-B:1640e4

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinica Ortopedica - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy

    A. Zanirato, M. Formica, S. Divano & L. Felli

  2. Ortopedia e Traumatologia 2 – Joint Replacement Unit – Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy

    L. Cavagnaro & G. Burastero

Authors
  1. A. Zanirato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Formica
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Cavagnaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Divano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Burastero
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Felli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Zanirato.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zanirato, A., Formica, M., Cavagnaro, L. et al. Metaphyseal cones and sleeves in revision total knee arthroplasty: Two sides of the same coin? Complications, clinical and radiological results—a systematic review of the literature. Musculoskelet Surg 104, 25–35 (2020). https://doi.org/10.1007/s12306-019-00598-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-019-00598-y

Keywords

Search

Navigation