Tibial tray cementation is not necessary for knee revision with titanium metaphyseal sleeves: a mid-term prospective study in AORI 2B defects

Abstract

PurposeMetaphyseal fixation with porous titanium sleeves in revision knee surgery provides mechanical support to the implant, promotes biological fixation, and has shown satisfactory short‐ and mid‐term results. Cement is commonly used to fix the tibial tray to the epiphyseal area. The objective of this study is to determine whether cement should be used to achieve fixation of the tibial tray with the hypothesis that metaphyseal sleeves would provide enough axial and rotational stability making cementation unnecessary. Material and methodsProspective study of 60 patients undergoing knee replacement surgery with metaphyseal sleeves in type 2B defects in femur and tibia. Patients were divided into two groups according to the use of cement on the tibial component. Analysis included the American Knee Society Score (KSS) knee and functional scales, the Western Ontario and McMaster Universities (WOMAC) index, the Short Form 12 (SF‐12) health survey, and radiographic assessment with a maximum follow‐up of 5 years. ResultsNo statistically significant differences were found between the two groups in any of the parameters assessed. ConclusionMetaphyseal sleeves showed a 100% survivorship at five years of followup. There were no differences in clinical and radiographic outcomes at five years of follow‐up depending on whether or not cement was used for tibial platform fixation. Cementation of the tibial tray would therefore not be required to achieve satisfactory mid‐term results. Level of evidenceLevel II: prospective cohort study. Therapeutic.

Metaphyseal cones and sleeves are similar in improving short- and mid-term outcomes in Total Knee Arthroplasty revisions

“…Cones or sleeves for both femur and tibia were used in 22 studies [1, 7, 10, 11, 13, 17, 18, 21, 22, 24–26, 29, 30, 33, 34, 42, 50, 54, 56, 58, 60], solely on the tibial side in seven studies [3, 5, 14, 28, 31, 35, 44] and on the femoral side in one study [51].…”

“…Eleven studies [5, 11, 13, 21, 22, 25, 29, 33, 42, 50, 60] reported intraoperative and postoperative fractures comprising a total of 48 out of 1032 patients.…”

“…Aseptic or septic loosening occurred in 15 out of 456 patients based on 6 studies [1, 5, 21, 25, 26, 29]. A total of 24 out of 734 patients experienced infection based on 9 studies [3, 5, 11, 21, 22, 25, 29, 42, 60].…”