Revision ArthroplastyPorous-Coated Metaphyseal Sleeves for Severe Femoral and Tibial Bone Loss in Revision TKA
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.