Mid-term results for metaphyseal sleeves in revision knee surgery

Martín-Hernández, C.; Floría-Arnal, L.J.; Muniesa-Herrero, M.P.; Espallargas-Doñate, Teresa; Blanco-Llorca, J.A.; Guillen-Soriano, Melchor; Ranera-García, M

doi:10.1007/s00167-016-4298-4

Cited by 48 publications

(73 citation statements)

References 25 publications

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“…In terms of load transfer, large engaging stems caused strain shielding in the proximal metaphysis, compared to stemless sleeved implants and sleeves with under‐sized stems. This is supported by recent clinical studies that have reported bone resorption in that region of the metaphysis in stemmed sleeved implants …”

Section: Discussionsupporting

confidence: 73%

“…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 …”

mentioning

confidence: 87%

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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

Awadalla

Al-Dirini

O’Rourke

et al. 2018

Journal Orthopaedic Research

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Traditionally, diaphyseal stems have been utilized to augment the stability of revision total knee replacement (rTKR) implants. More recently metaphyseal augments, such as sleeves, have been introduced to further augment component fixation. The effect of augments such as stems and sleeves have on the primary stability of a rTKR implant is poorly understood, however it has important implications on the complexity, costs and survivorship of the procedure. Finite element analysis was used to investigate the primary stability and strain distribution of various size stems and sleeves used in conjunction with a cementless revision tibial tray. The model was built from computer tomography images of a single healthy tibia obtained from an 81-year-old patient to which an Anderson Orthopaedic Research Institute (AORI) IIA defect was virtually added. The influences of varying body mass index (BMI) and bone modulus were also investigated. Stemless sleeves were found to provided adequate primary implant stability (average implant micro-motion <50 μm) for the studied defect. Addition of a stem did not enhance the primary stability. Furthermore, this study found that varying BMI and bone modulus had a considerable effect on strain distribution but negligible effect on micro-motion in the sleeve area. In conclusion, the addition of diaphyseal stem to a metaphyseal sleeve had little benefit in enhancing the primary stability of tibial trays augmented when simulating reconstructions of AORI IIA tibial defects. Additional studies are required to determine the relative benefit of the diaphyseal stem when using metaphyseal sleeves defects with more extensive bone loss. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1876-1886, 2018.

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Section: Discussionsupporting

confidence: 73%

mentioning

confidence: 87%

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

Awadalla

Al-Dirini

O’Rourke

et al. 2018

Journal Orthopaedic Research

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“…Several experimental and clinical studies advocated the use of a stem when using a revision prosthesis with a sleeve . However, including the stem adds distal fixation which can lead to proximal strain reduction, with some clinical reports of proximal metaphyseal bone resorption . The current literature lacks data regarding the biomechanical behavior and profile of the metaphyseal sleeve augmented implants in the presence or absence of a stem.…”

Section: Discussionmentioning

confidence: 99%

“…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 …”

mentioning

confidence: 99%

“…Metaphyseal sleeves, have been introduced to compensate for severe osseous defects and provide better zonal fixation in the metaphysis . Several clinical studies with short term follow up have suggested that using the metaphyseal sleeves without stems, can provide adequate initial implant stability when reconstructing tibiae with AORI type II and III defects . Gottsche et al used the rotating platform Sigma® MBT Revision tibial tray (DePuy Synthes Joint Reconstruction, Warsaw, IN) augmented with a sleeve and no stem to reconstruct all types of defects in 71 rTKR.…”

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confidence: 99%

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

Awadalla

Al-Dirini

O’Rourke

et al. 2019

Journal Orthopaedic Research

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Metaphyseal augments, such as sleeves, have been introduced to augment the fixation of revision total knee replacement (rTKR) components, and can be used with or without a stem. The effect of sleeve size in combination with stems on the primary stability and load transfer of a rTKR implant in AORI type IIB defects where the defect involves both condyles are poorly understood. The aim of this study was to examine the primary stability of revision tibial tray augmented with a sleeve in an AORI type IIB defect which involves both condyles with loss of cortical and cancellous bone. Finite element models were generated from computed tomography (CT) scans of nine individuals. All the bones used in the study had an AORI type IIB defect. The cohort included eight females (mean weight: 64 kg, height: 1.6 m). Material properties were sampled from CT data and assigned to the FE model. Joint contact forces for level gait, stair descent, and squat were applied. Stemless sleeved implants under various loading conditions were shown to have adequate primary stability in all AORI type IIB defects investigated. Adding a stem only marginally improved the primary stability of the implant but reduced the strain in the metaphysis compared to stemless implants. Once good initial mechanical stability was established with a sleeve, there was no benefit, in terms of primary stability or bone strains, from increasing sleeve size. This study suggests that metaphyseal sleeves, without a stem, can provide the required primary stability required by a rTKR tibial implant, to reconstruct an AORI type IIB defect. ß

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