Osteointegrative Sleeves for Metaphyseal Defect Augmentation in Revision Total Knee Arthroplasty: Clinical and Radiological 5-Year Follow-Up

Abstract

BackgroundCementless metaphyseal implant fixation of revision total knee arthroplasty has encouraging early results. We analyzed midterm results and implant survival of osteointegrative augments in Anderson Orthopedic Research Institute (AORI) type 2a, 2b, and 3 defects. Reasons for implant failure were explored and the potential for anatomic joint line reconstruction evaluated. MethodsSixty-seven consecutive patients (68 revision total knee arthroplasties) received cementless metaphyseal sleeves between 2011 and 2014. The mean follow-up was 5.0 years, mean age was 68.5 years, and mean body mass index was 31.4 kg/m2. The clinical and radiographic results were determined using established scoring systems. Additionally, the survival rate was calculated and reasons for failure were analyzed. ResultsIn 2 patients (4.3%), sleeves had to be removed early postoperatively for deep infection after second-stage reimplantation. With continuously functioning remaining implants, the aseptic survival rate was 93.6%. Cleared up for initial technical issues due to poor bone quality, it is as high as 98%. The scores remained to be significantly improved by 64.8 points (Western Ontario and McMaster Universities Osteoarthritis Index) and 25.8 points (Knee Society score) (P < .001). In 10 patients (29.4%), diaphyseal radiolucencies were observed without suspicion of loosening. The mean joint line was noted to be 0.36 mm lower to the anatomic level. ConclusionAt a mean follow-up of 5.0 years, cementless osteointegrative sleeves for metaphyseal fixation in AORI 2a, AORI 2b, and AORI 3 defects yielded continuous implant fixation even in cases with preceding revisions. The cleared up aseptic survival rate was 98% at 5 years. The modular sleeve design allowed joint line reconstruction near the anatomic level.