Fixation remains a challenge in Revision TKR. Irregular and cavitary bone loss may precludeproper metaphyseal cementation and pressurization. Metaphyseal sleeves have been proposed to improve theinherent rotational stability of the implant bone interface. The goal of this study was to assess the effect of the use of metaphyseal sleeves on the quality of the cement fixation achieved. Fifty consecutive revision TKRs for AORI type 2 and 3 bone loss between January 2005 through January 2008 with average 2 years follow up were assessed retrospectively. Twelve patients were excluded for inadequate follow up. Nineteen patients with 26 cemented metaphyseal sleeves (15 tibiae and 11 femora) formed group 1 and 19 patients with 36 revision components (without metaphyseal sleeves) served as control (group 2). Patients were assessed clinically with knee society scores (KSS) and radiographically by quality of metaphyseal cement mantle and radiolucent lines(RLL). Groups were matched for pre-op bone loss and length of follow-up.Introduction
Methods
Mechanical integrity of patella can be weakened by the technique of removing the articulating surface. The senior author developed the technique of maintaining subchondral bone of the lateral patellar facet in early 1980s. Though laboratory studies have demonstrated deleterious effect of excessive resection of patella on the strains in the remaining bone under load; clinical studies have not shown the importance of strong subchondral bone of lateral facet to have an effect on patellar fracture prevalence. We present the results of our patellar resection technique preserving the subchondral bone of lateral facet. 393 TKRs were performed between 1989 and 1996 using cruciate substituting modular knee with recessed femoral trochlear groove and congruent patello-femoral articulation. 45 patients with 48 knees died and 37 patients with 41 knees were lost to follow-up. Three hundred and four knees were followed for an average 10 years (range 5 -16 years). Patellar surface was resected with an oscillating saw without the use of cutting guide. The medial facet and most of the articular cartilage of the lateral facet was resected, while preserving the subchondral bone of lateral facet. An all-polyethylene implant with single peg was used in most cases.Introduction
Methods
