Cementless metaphyseal sleeves without stem in revision total knee arthroplasty

Abstract

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.

Influence of varying stem and metaphyseal sleeve size on the primary stability of cementless revision tibial trays used to reconstruct AORI IIA defects. A simulation study

“…Fourth, the overall alignment of the tibial construct remained constant throughout the study. Gottsche et al reported a wide variation in the tibio‐femoral angle of the patients investigated and patients with increase valgus reported worse patients reported outcomes. They speculated that this wide variation could be related to the fact that the sleeves were used to conduct the tibial cuts instead of using the manufacturers allocated cutting guides.…”

“…Several clinical studies have reported on the use of metaphyseal fixation with sleeves only to augment rTKR reconstruction of AORI type 2 and 3 bone defects . Although considered promising, the results are difficult to interpret.…”

“…Barrett et al reported no failures, but only 30% of the patients used metaphyseal sleeves without stems . Gottschhe et al reported 2.8% aseptic loosening at minimum 2 years follow‐up in 63 rTKR in which all cases used metaphyseal sleeves only to achieve implant stability . Agarwal et al reported that two out of six cases, in which tibial sleeves were used without a stem, loosened …”

“…Several clinical studies have reported on the use of metaphyseal sleeves alone, without stems, for the reconstruction of various types of bone defects as described by the Anderson Orthopaedic Research Institute (AORI) classification. These studies suggest that good short term stability is possible for these reconstructions at short term follow‐up . Of importance, some studies have reported metaphyseal bone resorption after such reconstructions, suggesting stress shielding …”

Influence of stems and metaphyseal sleeve on primary stability of cementless revision tibial trays used to reconstruct AORI IIB defects

“…Osseous defects of cases coming to rTKR are commonly categorized in accordance with the Anderson Orthopaedic Research Institute (AORI) Classification . AORI IIB defects, which consist of cancellous and cortical metaphyseal bone loss in both tibial/femoral condyles, are most common and are encountered in up to 42% of rTKR's …”