Metaphyseal sleeves in arthroplasty of the knee
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Christian Lycke1 · Dirk Zajonz2 · Alexander Brand1 · Torsten Prietzel2 · ChristophE. Heyde1 · Andreas Roth1 · Mohamed Ghanem1 1
© The Author(s) 2020
Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany 2 Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
Metaphyseal sleeves in arthroplasty of the knee A suitable tool in management of major metaphyseal bone loss
Introduction 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]. Periprosthetic osteolysis caused by polyethylene abrasion is one reason for bone defects, which are often seen in cases of loosening [10]. During revision surgery, 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. The management of these complicated cases can lead to longer operating times and thus to an increased risk of perioperative and postoperative complications [22]. Therefore, so-called metaphyseal sleeves are frequently used for the management of bone defects and have gained wide acceptance in revision arthroplasty of the knee [1]. These are cementless sleeves, which are anchored in the metaphysis of the femur and/or tibia as a modular part of the knee revision components. Combined with intramedullary stems, the sleeves are used to achieve a durable and stable anchorage situation in a deficient metaphyseal bone situation. The intramedullary stems are
press-fitted into the medulla of the femur and/or tibia and provide additional stability in the diaphysis. This study was carried out to examine 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 with revision arthroplasty.
Material and methods Prior to conducting this study a positive vote of the local ethics committee (Votum-No. 236/19-ek) was obtained. From May 2011 to March 2019, we identified patients who had undergone aseptic arthroplastic surgery of the knee with significant metaphyseal bone defects of the femur and/or tibia (. Fig. 1) or major proximal diaphyseal defects due to inlay wear (. Fig. 2). We evaluated patient data and conducted a clinical and radiological follow-up examination of the patients. In order to have a homogeneous study group, we included patients with revision arthroplasty of the knee and metaphyseal bone defects grade III according to the AORI classification [9]. The major tibial and femoral bone deficiency situation and instability
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