Abstract
BackgroundThis study examined the clinical outcome following revision arthroplasty of the knee joint and severe arthrosis with metaphyseal bone defects and instability using metaphyseal sleeves. We analyzed the results based on established scores and recorded the complications occurring on revision arthroplasty.Material and methodsPatients with revision arthroplasty of the knee and metaphyseal bone defects grade III according to the Anderson Orthopedic Research Institute (AORI) classification were included (16 patients, 9 females and 7 males). In all cases, surgery was performed using an endoprosthesis COMPLETE™ revision knee system with metaphyseal sleeves.ResultsAll patients had a significant reduction in pain level after revision surgery. The median HSS score in the cohort with primary arthroplasty was 84 and in the cohort with revision arthroplasty 73 and the KSS was 83 and 55, respectively. According to the HSS an excellent result was achieved by 50% of the patients in the primary arthroplasty group and 25% in the revision group. Only three patients were considered to have an insufficient result. Postoperative pain was significantly reduced in both groups. The median ROM was 112° flexion in the primary arthroplasty group and 95° in the revision group. An extension deficit was observed in three patients and four patients showed prolonged wound healing postoperatively (25%), which was treated conservatively and did not lead to septic changes.ConclusionThe use of metaphyseal sleeves in patients with bone defects is a suitable instrument with no negative impact on the outcome both in primary and revision arthroplasty. Further studies with larger study groups and analysis of long-term results after use of such endoprosthetic components should be conducted.
Highlights
With increasing numbers of primary total knee arthroplasty, the number of revision operations on the knee joint is increasing [6, 25], often due to infections, wear of modular parts, periprosthetic fractures or aseptic loosening [18, 20]
This study examined the clinical outcome following revision arthroplasty of the knee joint and severe arthrosis with metaphyseal bone defects and instability using metaphyseal sleeves
The median HSS score in the cohort with primary arthroplasty was 84 and in the cohort with revision arthroplasty 73 and the KSS was 83 and 55, respectively
Summary
With increasing numbers of primary total knee arthroplasty, the number of revision operations on the knee joint is increasing [6, 25], often due to infections, wear of modular parts, periprosthetic fractures or aseptic loosening [18, 20]. Explantation of components is usually accompanied by an increase of bone defects, especially in osteopenia or osteoporotic bones In these situations, with significant bone loss in the metaphyseal part of the femur and/or the tibia, the exact positioning and permanent fixation of the revision components can be impaired. With significant bone loss in the metaphyseal part of the femur and/or the tibia, the exact positioning and permanent fixation of the revision components can be impaired The management of these complicated cases can lead to longer operating times and to an increased risk of perioperative and postoperative complications [22]. Surgery was performed using an endoprosthesis COMPLETETM revision knee system with metaphyseal sleeves
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