Elsevier

The Journal of Arthroplasty

Volume 32, Issue 11, November 2017, Pages 3468-3473
The Journal of Arthroplasty

Revision Arthroplasty
Porous-Coated Metaphyseal Sleeves for Severe Femoral and Tibial Bone Loss in Revision TKA

https://doi.org/10.1016/j.arth.2017.06.025Get rights and content

Abstract

Background

Metaphyseal bone loss is commonly encountered in revision total knee arthroplasty (TKA). Anderson Orthopaedic Research Institute types 2 and 3 defects generally require some form of metaphyseal fixation or augmentation. This study evaluates the midterm results of stepped, porous-coated metaphyseal sleeves in revision TKA in the setting of severe bone loss.

Methods

Patients who underwent revision TKA using metaphyseal sleeves from March 2006 to May 2014 at our institution were identified from a prospective research database. Preoperative patient characteristics and operative data were reviewed. Postoperative outcomes were compared with preoperative values. Primary study outcomes included complications, reoperations, radiographic assessment of sleeve osteointegration, and survivorship.

Results

One hundred sixteen knees (108 patients) underwent revision TKA with 152 metaphyseal sleeves (111 tibial and 41 femoral). Anderson Orthopaedic Research Institute defect classification included 5 type 2A, 89 type 2B, and 17 type 3 tibial defects; and 3 type 2A, 34 type 2B, and 4 type 3 femoral defects. There were 3 intraoperative fractures (1.9%) associated with sleeve preparation and/or insertion. Six knees (5 patients) were lost to follow-up and 5 patients (6 knees) died before 2 years. Of the remaining 104 knees (98 patients, 134 sleeves), mean follow-up was 5.3 years (range 2-9.6 years). Nineteen knees (16.4%) required reoperation, most commonly for recurrent infection. Only one sleeve demonstrated radiographic evidence of failed osteointegration, but did not require revision. Two sleeves (1.5%) required removal and/or resection for recurrent infection.

Conclusion

This large retrospective series illustrates the utility of porous metaphyseal sleeves in revision TKA with a low rate of intraoperative complications, excellent osteointegration, and long-term fixation.

Section snippets

Materials and Methods

We identified all patients who had undergone revision TKA using stepped, porous-coated, titanium metaphyseal sleeves (DePuy Synthes, Warsaw, IN) at our institution from 2006-2014 from a prospective research database. This consecutive series consisted of all patients who underwent a tibial and/or femoral revision with a bone defect classified as AORI type 2 or 3. Preoperative patient demographics (Table 1), indications for revision surgery (Table 2), and operative data, including AORI

Results

The most common indication for revision surgery was aseptic loosening in 29 knees (25%), followed by 2-stage reimplantation from an antibiotic spacer for the treatment of infection in 28 knees (24%; Table 2). Statistically significant improvements were noted in knee range of motion and KSSs (Table 4) from preoperative values. Nonprogressive radiolucent lines were identified beneath the tibial baseplate in 18 knees (17%), all of which showed excellent sleeve osteointegration and no radiographic

Discussion

Bone loss is frequently encountered in revision TKA and managing osseous defects is vital to obtain adequate fixation to provide a durable and functional reconstruction. Traditional treatment strategies relying on bulk structural allograft, allograft-prosthetic composites, or impaction grafting [4], [5], [6], [7], [8], [9], [10], [11] have all shown some success, but there are significant concerns regarding graft resorption and these reconstructions can be technically challenging. The

Conclusion

We report the clinical results of revision TKA in which 134 metaphyseal sleeves were used for types 2 and 3 bone defects. Despite an overall reoperation rate of 16.4%, we observed only one case (0.7%) of failed osteointegration and observed a 98.5% all-cause sleeve survivorship. This large retrospective series illustrates the utility of porous-coated metaphyseal sleeves in revision TKA with a low rate of intraoperative fracture, excellent osteointegration, and lasting fixation.

Acknowledgments

The authors would like to thank Rose Johnson and Catherine Eschen for their help with data collection, manuscript formatting, and submission of this manuscript. They would like to thank Dr Brian Haas for the contribution of his patients to this data set. They would also like to thank the entire office staff and clinicians at Colorado Joint Replacement for their continued efforts in research. The information captured in our database would not be possible without their assistance. No funding was

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.06.025.

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