Abstract
Introduction
Bone loss in the distal femur and proximal tibia is frequently encountered with both complex primary and revision knee replacement surgery. Metaphyseal sleeves provide a good option for enhanced fixation in managing such defects on both the tibia and femur. We present our results in 48 patients (50 knees) with a minimum 12 month follow up (range 12 to 45).
Methods
48 patients (50 knees) who had revision knee arthroplasty for either septic or aseptic loosening. All were graded Type II or III using the Anderson Orthopaedic Research Institute (AORI) grading system of both femoral and tibial defects. A large portion of aseptic loosening revisions were for extreme osteolysis of a bicondylar knee prosthesis.
Results
52% had tibial sleeves only, 38% had both tibial and femoral sleeves and the remainder had only femoral sleeves inserted. All knee radiographs at final follow-up showed well-fixed osteointegrated components without component migration or clinically significant osteolysis. Two knees were treated with multiple arthroscopic washouts for infection. Two knees subsequently underwent manipulation under anaesthesia with good improvement in range of movement. One subsequently developed Complex Regional Pain Syndrome. No femoral or tibial components were revised. The average pre-operative Oxford Knee Score was 22 (12 to 38) and subsequently improved to 38 (12 to 45) post-operatively.
Discussion and conclusions
Our early results show encouraging signs that porous titanium sleeves are a good option when managing large metaphyseal bone loss in both femur and tibia especially in revision arthroplasty. Post operative complications were low and functional outcome scores were comparable with more traditional knee revision arthroplasty techniques in the presence of bone loss.
