Metaphyseal sleeves as the primary implant for the management of bone defects in total knee arthroplasty after post-traumatic knee arthritis.

BACKGROUND: Implantation of a prosthesis after post-traumatic knee arthritis poses challenges derived from the bone defects and soft tissue damage. The objective of this study was to evaluate the clinical and radiological results of the use of metaphyseal sleeves in primary total knee arthroplasty surgery after post-traumatic arthritis. METHODS: Clinical and radiological results of 25 patients undergoing surgery for post-traumatic knee arthritis were prospectively evaluated. A semi-constrained, mobile platform prosthesis with metaphyseal sleeves was implanted. American Knee Society scales, Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Short Form 12 Health Survey were used. Patients were evaluated at the baseline and at postoperative months three, 12, and annually until final follow-up. RESULTS: The mean follow-up was 79 months with a maximum of 10 years. Mean Knee Society Score (KSS) increased from 29 to 78, and functional KSS from 42 to 81. The average WOMAC pain index changed from 12 to three; average WOMAC stiffness improved from four to one, and WOMAC function score improved from 44 to 16. The mean physical SF12 varied from 30 to 46, while mental SF-12 varied from 45 to 55. Radiological osseointegration of the implants was considered optimal in all cases, with a survival of 100%. CONCLUSIONS: Metaphyseal sleeves in combination with varus-valgus constrained (VVC) components and a rotating platform, have shown good clinical and radiological results in patients with post-traumatic knee arthritis and constitute a reliable alternative for treatment of this disease when the epiphyseal zone is deteriorated and has bone defects.

Mid-term results for metaphyseal sleeves in revision knee surgery.

PURPOSE: Metaphyseal titanium sleeves have been used to provide cementless fixation in challenging bone defects in revision knee arthroplasty. The aim of this study was to evaluate the mid-term results of radiological and clinical outcomes, for metaphyseal sleeves in type 1B and 2 defects of tibia and femur under the hypothesis that they would provide stable and prolonged fixation. METHODS: One hundred and thirty-four patients were included in a prospective study to evaluate the outcomes of knee revision with sleeves, together with stems and varus-valgus constrained mobile bearing prosthesis. Median follow-up was 71.5 months (range 36-107). Analysis included American Knee Society Score (KSS), Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), SF12 Health Survey and radiographic assessment. RESULTS: All clinical scores improved significantly in all patients during the follow-up. The median of Knee KSS increased from 33 to 78 and functional KSS from 30 to 80. The median of WOMAC pain index changed from 12 to 4; pre-operative median of WOMAC stiffness and WOMAC function score improved from 5 to 2 and from 45 to 14, respectively. The median of physical SF12 varied from 27 to 44, while mental SF-12 from 43 to 54. Radiological evaluation showed optimal osseous integration in all patients, and neither implant migration nor progressive radiolucency around components was observed. Complications included three cases of end-of-stem pain at tibial side and two revisions due to septic loosening in the first post-operative year. No aseptic loosening was reported. CONCLUSION: The use of metaphyseal sleeves, in combination with uncemented stems and varus-valgus constrained components with rotating platform, has shown excellent mid-term results allowing osseous ingrowth with no evidence of osteolysis or displacement. This is a promising option for better implant fixation in revision TKA. LEVEL OF EVIDENCE: Case series with no comparison group, Level IV.