Use of Stepped Porous Titanium Metaphyseal Sleeves for Tibial Defects in Revision Total Knee Arthroplasty: Short Term Results

Barnett, Steven; Mayer, Ryan; Gondusky, Joseph S; Choi, Leera; Patel, Jay; Gorab, Robert S.

doi:10.1016/j.arth.2013.12.026

Cited by 95 publications

(102 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This has highlighted the need for greater understanding of the biological interactions that take place when developing materials to be used in advanced surgical technologies, particularly in order to meet the requirements of what most likely will be a tighter regulatory framework [30][31][32]. We are investigating a cellular approach to enhancing soft tissue graft integration with bone using patient-derived HF-hMSCs and in this study carried out a preliminary investigation of these cells in response to a standard, Ti interference screw which is increasingly used clinically for ACL repair particularly when undertaking revision surgeries [33,34]. Previous reports have demonstrated the in vitro attachment of MSCs to Ti surfaces, and this is confirmed by our electron micrograph data [24,35].…”

Section: Discussionmentioning

confidence: 99%

Investigating the biological response of human mesenchymal stem cells to titanium surfaces

German¹,

Osei-Bempong²,

Knuth³

et al. 2014

Journal of Orthopaedic Surgery and Research

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Investigating the biological response of human mesenchymal stem cells to titanium surfaces

German¹,

Osei-Bempong²,

Knuth³

et al. 2014

Journal of Orthopaedic Surgery and Research

View full text Add to dashboard Cite

show abstract

“…This reconstructive approach requires careful preoperative preparation, meticulous operative technique to maximize surface contact between the allograft and the host bone, availability of large structural allografts, and considerable experience in complex knee arthroplasty [26,34]. Advantages of this technique include relative cost effectiveness, the ability to create any shape or size of construct according to the bone defect, excellent support of the revision implant, the potential for long-term biologic integration of the graft restoring host bone stock, and the potential for ligamentous reattachment [2]. Disadvantages include technical difficulty and prolonged operative times required to fashion the grafts, limited availability of adequate graft, nonunion, delayed union, collapse, graft resorption, graft infection, and the possibility of disease transmission [2,34].…”

Section: Bulk Structural Allograftsmentioning

confidence: 99%

“…However, cones and sleeves differ at the interface of the augment with the revision prosthesis. Metaphyseal sleeves are implant-specific and mated to the revision implant by a Morse taper and therefore avoid the necessity of cement in the final construct [2,6]. Conversely, a variety of prosthetic devices can be cemented into the inner, central surface of many metaphyseal cone designs [34].…”

Section: Metaphyseal Cones and Sleevesmentioning

confidence: 99%

“…At final follow-up, two (2.7 %) tibial components required revision for aseptic loosening. Barnett et al retrospectively reviewed data on 40 patients who underwent revision TKA utilizing a metaphyseal sleeve for type 2 and 3 tibial defects [2]. At a mean of 38 months, four revision procedures were necessary, but none for aseptic loosening.…”

Section: Metaphyseal Cones and Sleevesmentioning

confidence: 99%

“…Advantages of this technique include relative cost effectiveness, the ability to create any shape or size of construct according to the bone defect, excellent support of the revision implant, the potential for long-term biologic integration of the graft restoring host bone stock, and the potential for ligamentous reattachment [2]. Disadvantages include technical difficulty and prolonged operative times required to fashion the grafts, limited availability of adequate graft, nonunion, delayed union, collapse, graft resorption, graft infection, and the possibility of disease transmission [2,34]. Failure of bulk structural allografts in revision TKA has been associated with a reoperation rate of 8 to 23 % [1,3,5,14,23].…”

Section: Bulk Structural Allograftsmentioning

confidence: 99%

See 2 more Smart Citations

Metaphyseal bone loss in revision knee arthroplasty

Ponzio

Austin

2015

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

The etiology of bone loss encountered during revision total knee arthroplasty (TKA) is often multifactorial and can include stress shielding, osteolysis, osteonecrosis, infection, mechanical loss due to a grossly loose implant, and iatrogenic loss at the time of implant resection. Selection of the reconstructive technique(s) to manage bone deficiency is determined by the location and magnitude of bone loss, ligament integrity, surgeon experience, and patient factors including the potential for additional revision, functional demand, and comorbidities. Smaller, contained defects are reliably managed with bone graft, cement augmented with screw fixation, or modular augments. Large metaphyseal defects require more extensive reconstruction such as impaction bone grafting with or without mesh augmentation, prosthetic augmentation, use of bulk structural allografts, or use of metaphyseal cones or sleeves. While each technique has advantages and disadvantages, the most optimal method for reconstruction of large metaphyseal bone defects during revision TKA is not clearly established.

show abstract

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

View full text Add to dashboard Cite

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.

show abstract

Use of Stepped Porous Titanium Metaphyseal Sleeves for Tibial Defects in Revision Total Knee Arthroplasty: Short Term Results

Cited by 95 publications

References 27 publications

Investigating the biological response of human mesenchymal stem cells to titanium surfaces

Investigating the biological response of human mesenchymal stem cells to titanium surfaces

Metaphyseal bone loss in revision knee arthroplasty

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

Contact Info

Product

Resources

About