Metaphyseal Sleeves in Revision Total Knee Arthroplasty

Abstract

The rate of revision total knee revision arthroplasty (TKR) is increasing and will continue to increase. Addressing bone loss during TKRs continues to be a major challenge and is necessary to provide a stable construct. Current techniques for addressing bone loss include using cement, bone graft (structural or morselized), augments, custom-made implants, or metaphyseal filling implants. Metaphyseal filling implants include metaphyseal sleeves and tantalum cones, and they achieve stability by osteointegration with metaphyseal bone. The indications for using metaphyseal sleeves include addressing bone loss, adding stability to the prosthesis–bone construct, and providing long-term fixation of the implant to bone. Metaphyseal sleeves are implanted using a broach technique that prepares the metaphyseal bone and reduces bony gaps. The sleeves attach to stems by Morse taper instead of creating a cement interface, and sleeves are available for both tibial and femoral fixation. Care must be taken when broaching and placing implants to reduce the risk of fracture, and weight-bearing status will vary according to the procedure performed. By using the techniques described in this article for placing metaphyseal sleeves, stable TKR constructs may be achieved.