Comparative Analysis between Cone and Sleeve in Managing Severe Bone Defect during Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Kim, Hyun Jung; Lee, O-Sung; Lee, Jun Young; Lee, Yong Seuk

doi:10.1055/s-0037-1606564

Cited by 18 publications

(22 citation statements)

References 35 publications

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“…Bone loss may be treated with different options, depending on the severity of the defect and the quality of bone losses, including cement, impaction bone graft, traditional metal augments, structural allograft, tantalum cones, or sleeves [8, 9]. Particularly, tantalum cones have been relatively recently introduced to treat major bone loss, with good outcomes [13, 39, 40]. Different authors described the biomechanical properties of tantalum, including high biocompatibility, high density, and possibility of porous structure with increased osteoconductive properties [41].…”

Section: Discussionmentioning

confidence: 99%

“…The biological and mechanical properties of tantalum cones are well known [14]. Considering the osteoconductive properties of tantalum, it is reasonable to think that it may allow for a stronger fixation in the metaphyseal zone, reducing the forces on the epiphyseal zone and, consequently, the risk for aseptic loosening [12, 39, 44]. However, surgeons have to be careful because the internal diameter of the cone may limit the diameter of the stem, or the use of an offset, possibly resulting in suboptimal Canal Fill Ratio (CFR).…”

Section: Discussionmentioning

confidence: 99%

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Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

et al. 2019

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Background Revision total knee arthroplasty (rTKA) is a demanding procedure, with a high complication and failure rate and a high rate of bone losses and poor bone quality. Different classifications for bone losses have been proposed, but they do not consider bone quality, which may affect implant fixation. The aim of this study is to describe the outcomes of a consecutive series of rTKA. Furthermore, a modified bone loss classification will be proposed based also on bone quality. Finally, the association between radiolucent line (RLL) development and different risk factors will be evaluated. Methods All the patients who underwent rTKA between 2008 and 2016 in the same institution were included. rTKAs were performed by the same surgeon according to the three-step technique. Bone losses were classified according to the proposed classification, including bone quality evaluation. The Knee Scoring System (KSS), the Hospital for Special Surgery Knee Score (HSS), and the SF-12 were used for the clinical evaluation. Radiological evaluation was performed according to the Knee Society Roentgenographic Evaluation System. Different possible risk factors (i.e., gender, age, amount of bone losses) associated to RLL development were identified, and this association was evaluated using logistic regression. Results Fifty-one patients (53 knees) were included (60.8% female, average age 71.5 years). The average follow-up was 56.6 months (range 24–182). The most frequent cause of failure was aseptic loosening (41.5%). 18.9% of the cases demonstrated poor bone quality. Bone losses were treated according to the proposed algorithm. In all the cases, there was a significant improvement in all the scores ( P < 0.05). The average post-operative range of motion was 110.5° (SD 10.7). At the radiological evaluation, all the implants resulted well aligned, with 15.1% of non-progressive RLL. There were 2 failures, with a cumulative survivorship of 92.1% at the last follow-up (SD 5.3%). At the logistic regression, none of the evaluated variables resulted associated to RLL development. Conclusion rTKA is a demanding procedure, and adequate treatment of bone losses is mandatory to achieve good results. However, also bone quality should be taken into consideration when approaching bone losses, and the proposed classification may need surgeons after an adequate validation. Level of evidence Level IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment

et al. 2019

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“…In addition to antibiotic therapy, a radical debridement of the situs is essential to ensure infection eradication. However, the preservation of good bone stock is the basis for a successful reimplantation of a new implant [ 11 ]. For fixation, two different zones should be used.…”

Section: Introductionmentioning

confidence: 99%

“…To provide good stability, the fixation is based on both the metaphysis and diaphysis. Cemented or cementless stems are used for the fixation in the diaphysis [ 11 , 12 ]. In recent years, sleeves and cones were established for augmentation of metaphysical defects and represent the new gold standard.…”

Section: Introductionmentioning

confidence: 99%

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Individual Revision Knee Arthroplasty Is a Safe Limb Salvage Procedure

Savov

Tuecking

Ettinger

2021

JPM

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Introduction: Revision total knee arthroplasty after multiple pre-surgeries is challenging. Due to severe bone defects, standard implants for metaphyseal and diaphyseal anchoring may no longer be suitable. The primary aim of this case series is to evaluate the early complication rate for individual knee implants with custom-made cones and stems after two-stage revision with severe bone defects. Methods: Ten patients who were treated with custom-made 3D-printed knee revision implants were included. Inclusion criteria were a two-stage revision due to late-onset or chronic periprosthetic joint infection as well as aseptic loosening. All severe bone defects were AORI type III. All procedure-related complications were evaluated. Postoperative range of motion after one year was measured. The time between the two surgeries was evaluated. Results: The mean follow-up was 21 months (range: 12–40). The mean time between the two-stage surgeries was 71.6 days. No fractures were observed intra- and postoperatively. Two patients were revised without changing metal components due to persistent hematoma (three weeks post-surgery) and persistent PJI (three months post-surgery). The mean passive postoperative range of motion was 92° (range: 80–110°). Conclusions: Individual custom-made implants for rTKA provide a safe procedure for patients with huge bone defects after several pre-surgeries. If standard knee systems with standard cones or sleeves are not suitable anymore, custom-made treatment offers the patient the last option for limb preservation. However, this is associated with increased costs.

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