Osteointegration of Non-Cemented Metaphyseal Sleeves in Revision Total Knee Arthroplasty

Introduction:

Non-cemented, porous-coated metaphyseal sleeves have been designed to improve biologic fixation and stability in revision total knee arthroplasty (TKA) with major bone defects. The aim of this study was to evaluate the clinical results and osteointegration of these sleeves in major bone loss.

Materials and Methods:

Between 2008 and 2011, 24 revision TKAs with major bone loss were reconstructed with non-cemented, porous-coated proximal sleeve (DePuy, Warsaw, IN). All patients were prospectively followed for a minimum of 2 years. Indications for use of sleeves were major metaphyseal tibial and femoral bone loss, younger age, and higher activity level. Osteointegration around the sleeves were classified as:

1. –

   Grade 1: Complete osteointegration in all views without any demarcation.

2. –

   Grade 2: Sleeves that are not completely osteointegrated but they are stable.

Grade 2A: Demarcation less than 2 mm on any view

Grade 2B: Demarcation more than 2 mm on any view

1. –

   Grade 3: Sleeves that are not osteointegrated and unstable with evidence of subsidence.

Grade 3A: Subsidence less than 2 mm on any view

Grade 3B: Subsidence more than 2 mm on any view

Results:

Mean range of motion and Knee Society Scores were 108 degrees and 92 respectively. 14 cases were revised for aseptic loosening and 10 cases for infection (which were treated with two stage revision arthroplasty). There was no malalignment, subsidence or re-revision at final follow-up. All sleeves were osteointegrated with majority grade 1 or 2a.

Discussion and conclusion:

Short-term results of non-cemented metaphyseal sleeves in major bone loss for loosening of infection demonstrated excellent clinical results and osteointegration.