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CC BY-NC-ND 4.0 · Joints 2017; 05(04): 207-211
DOI: 10.1055/s-0037-1607427
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Revision Total Knee Arthroplasty with Metaphyseal Sleeves without Stem: Short-Term Results

Giacomo Stefani
1   Dipartimento Di Ortopedia 2, Istituto Clinico “Città di Brescia,” Brescia, Italy
,
Valerio Mattiuzzo
1   Dipartimento Di Ortopedia 2, Istituto Clinico “Città di Brescia,” Brescia, Italy
,
Greta Prestini
1   Dipartimento Di Ortopedia 2, Istituto Clinico “Città di Brescia,” Brescia, Italy
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Publikationsverlauf

Publikationsdatum:
30. Oktober 2017 (online)

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Abstract

Purpose The aim of this study was to evaluate the efficacy of revision total knee arthroplasty (TKA) with cementless metaphyseal sleeves without stems either in the femoral or tibial side or in both.

Methods In this retrospective study, 51 patients (51 knees) operated in the period 2010 to 2015 met the above-mentioned criteria and were invited to a medical examination including X-rays. Forty-six were available for the study. Mean follow-up was 37 months. Knee Society score (KSS) (objective knee score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and range of motion (ROM) were used as outcome scores and compared with baseline values. X-rays were also examined and compared with postoperative exams to evaluate the presence of loosening, radiolucent lines, and bone ingrowth. Satisfaction of the patients was also investigated using a linear scale from 1 to 10.

Results KSS improved from 39 to 77 (p < 0.01); WOMAC score improved from 76 to 41 (p < 0.01). Twenty-four (52%) patients were satisfied, 15 (32%) were partially satisfied, and 7 (16%) were unsatisfied. ROM improved from 93 to 96 degrees (nonsignificant difference). X-rays showed no loosening of the implants, radiolucent lines in 4 patients (3 of them were asymptomatic) and bone ingrowth in 43 out of 46 patients.

Conclusion In this short-term retrospective study, the use of sleeves without stem was a safe and effective procedure in revision TKA. We found a significant improvement in clinical results compared with baseline values and no signs of implant loosening.

Level of Evidence Level IV, therapeutic case series.

Keywords

knee - total knee arthroplasty - revision - methaphyseal sleeves - results
 

  • References

  • 1 Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86-A (05) 963-974
    PubMedGoogle Scholar
  • 2 Rodriguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 2001; (388) 10-17
    PubMedGoogle Scholar
  • 3 Schai PA, Thornhill TS, Scott RD. Total knee arthroplasty with the PFC system. Results at a minimum of ten years and survivorship analysis. J Bone Joint Surg Br 1998; 80 (05) 850-858
    CrossrefPubMedGoogle Scholar
  • 4 Scuderi GR, Insall JN, Windsor RE, Moran MC. Survivorship of cemented knee replacements. J Bone Joint Surg Br 1989; 71 (05) 798-803
    PubMedGoogle Scholar
  • 5 Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 2003; 85-A (02) 259-265
    PubMedGoogle Scholar
  • 6 Swedish Knee Arthroplasty Register. Annual Report 2014 . Available at: http://www.myknee.se/pdf/SKAR2014_Eng_1.1.pdf
    PubMedGoogle Scholar
  • 7 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    Google Scholar
  • 8 Engh GA, Ammeen DJ. Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect 1999; 48: 167-175
    PubMedGoogle Scholar
  • 9 Fehring TK, Odum S, Olekson C, Griffin WL, Mason JB, McCoy TH. Stem fixation in revision total knee arthroplasty: a comparative analysis. Clin Orthop Relat Res 2003; (416) 217-224
    PubMedGoogle Scholar
  • 10 Whaley AL, Trousdale RT, Rand JA, Hanssen AD. Cemented long-stem revision total knee arthroplasty. J Arthroplasty 2003; 18 (05) 592-599
    CrossrefPubMedGoogle Scholar
  • 11 Manopoulos P, Havet E, Pearce O, Lardanchet JF, Mertl P. Mid- to long-term results of revision total knee replacement using press-fit intramedullary stems with cemented femoral and tibial components. J Bone Joint Surg Br 2012; 94 (07) 937-940
    PubMedGoogle Scholar
  • 12 Whiteside LA. Morselized allografting in revision total knee arthroplasty. Orthopedics 1998; 21 (09) 1041-1043
    PubMedGoogle Scholar
  • 13 Dorr LD, Ranawat CS, Sculco TA. , et al. Bone graft for tibial defects in total knee arthroplasty. Clin Orthop Relat Res 1986; (205) 153-165
    PubMedGoogle Scholar
  • 14 Bauman RD, Lewallen DG, Hanssen AD. Limitations of structural allograft in revision total knee arthroplasty. Clin Orthop Relat Res 2009; 467 (03) 818-824
    CrossrefPubMedGoogle Scholar
  • 15 Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 2016; 98-B (1, suppl A): 120-124
    CrossrefPubMedGoogle Scholar
  • 16 Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am 2008; 90 (01) 78-84
    CrossrefPubMedGoogle Scholar
  • 17 Kamath AF, Lewallen DG, Hanssen AD. Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. J Bone Joint Surg Am 2015; 97 (03) 216-223
    CrossrefPubMedGoogle Scholar
  • 18 Haidukewych GJ, Hanssen A, Jones RD. Metaphyseal fixation in revision total knee arthroplasty: indications and techniques. J Am Acad Orthop Surg 2011; 19 (06) 311-318
    CrossrefPubMedGoogle Scholar
  • 19 Dalury DF, Barrett WP. The use of metaphyseal sleeves in revision total knee arthroplasty. Knee 2016; 23 (03) 545-548
    CrossrefPubMedGoogle Scholar
  • 20 Bugler KE, Maheshwari R, Ahmed I, Brenkel IJ, Walmsley PJ. Metaphyseal sleeves for revision total knee arthroplasty: good short-term outcomes. J Arthroplasty 2015; 30 (11) 1990-1994
    CrossrefPubMedGoogle Scholar
  • 21 Graichen H, Scior W, Strauch M. Direct, cementless, methaphyseal fixation in knee revision arthroplasty with sleeves: short-term results. J Arthroplasty 2015; 30 (12) 2256-2259
    CrossrefPubMedGoogle Scholar
  • 22 Barrack RL, Rorabeck C, Burt M, Sawhney J. Pain at the end of the stem after revision total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 216-225
    PubMedGoogle Scholar
  • 23 Morgan-Jones R, Oussedik SI, Graichen H, Haddad FS. Zonal fixation in revision total knee arthroplasty. Bone Joint J 2015; 97-B (02) 147-149
    CrossrefPubMedGoogle Scholar
  • 24 Bieger R, Huch K, Kocak S, Jung S, Reichel H, Kappe T. The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods. Arch Orthop Trauma Surg 2014; 134 (04) 537-541
    CrossrefPubMedGoogle Scholar
  • 25 Shen C, Lichstein PM, Austin MS, Sharkey PF, Parvizi J. Revision knee arthroplasty for bone loss: choosing the right degree of constraint. J Arthroplasty 2014; 29 (01) 127-131
    CrossrefPubMedGoogle Scholar
  • 26 Mortazavi SM, Molligan J, Austin MS, Purtill JJ, Hozack WJ, Parvizi J. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop 2011; 35 (08) 1157-1164
    CrossrefPubMedGoogle Scholar
  • 27 Ghomrawi HMK, Kane RL, Eberly LE, Bershadsky B, Saleh KJ. ; North American Knee Arthroplasty Revision (NAKAR) Study Group. Patterns of functional improvement after revision knee arthroplasty. J Bone Joint Surg Am 2009; 91 (12) 2838-2845
    CrossrefPubMedGoogle Scholar
  • 28 Schroer WC, Berend KR, Lombardi AV. , et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 2013; 28 (8, Suppl): 116-119
    CrossrefPubMedGoogle Scholar