Mid-term clinical and radiographic outcomes of porous-coated metaphyseal sleeves used in revision total knee arthroplasty
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
The management of bone defects remains one of the major challenges surgeons are faced with in revision total knee arthroplasty (RTKA). Large and uncontained bone defects are traditionally managed with metaphyseal sleeves that facilitate osseointegration and have reported construct stability. While many studies have presented excellent short-term outcomes using metaphyseal sleeves, less is known on their performance in the longer term. The purpose of this study was to present our mid-term results of the metaphyseal sleeves used in patients undergoing RTKA. Between January 2007 and January 2015, 30 patients underwent RTKA with the use of a CCKMB prosthesis combined with an osteointegrative sleeve. The main indications for RTKA were instability in 40% of the cases ( n = 12), aseptic loosening in 30% ( n = 9), infection in 26.7% ( n = 8), and “other” in 3.3% ( n = 1). The minimal follow-up time was 5 years and the mean follow-up time was 82.4 months (SD = 22.6). Clinical outcomes were assessed by Knee Society scores (KSS), range of motion and rate of re-operation. The mean Knee Society score increased significantly from 72.1 preoperatively to 90.0 postoperatively ( p < 0.001). The cumulative incidence of re-operation in our study was 13.3% ( n = 4). Our study reported no cases of aseptic loosening or mobile-bearing spin-out. Knee flexion to 90° and more was impossible in seven cases (23.3%) preoperatively and in one case (3.3%) postoperatively. Porous-coated metaphyseal sleeves demonstrated excellent rates of survivorship and radiographic ingrowth in the mid-term setting. However, further studies are required to assess their outcomes in the long-term.
Abstract
The management of bone defects remains one of the major challenges surgeons are faced with in revision total knee arthroplasty (RTKA). Large and uncontained bone defects are traditionally managed with metaphyseal sleeves that facilitate osseointegration and have reported construct stability. While many studies have presented excellent short-term outcomes using metaphyseal sleeves, less is known on their performance in the longer term. The purpose of this study was to present our mid-term results of the metaphyseal sleeves used in patients undergoing RTKA. Between January 2007 and January 2015, 30 patients underwent RTKA with the use of a CCKMB prosthesis combined with an osteointegrative sleeve. The main indications for RTKA were instability in 40% of the cases ( n = 12), aseptic loosening in 30% ( n = 9), infection in 26.7% ( n = 8), and “other” in 3.3% ( n = 1). The minimal follow-up time was 5 years and the mean follow-up time was 82.4 months (SD = 22.6). Clinical outcomes were assessed by Knee Society scores (KSS), range of motion and rate of re-operation. The mean Knee Society score increased significantly from 72.1 preoperatively to 90.0 postoperatively ( p < 0.001). The cumulative incidence of re-operation in our study was 13.3% ( n = 4). Our study reported no cases of aseptic loosening or mobile-bearing spin-out. Knee flexion to 90° and more was impossible in seven cases (23.3%) preoperatively and in one case (3.3%) postoperatively. Porous-coated metaphyseal sleeves demonstrated excellent rates of survivorship and radiographic ingrowth in the mid-term setting. However, further studies are required to assess their outcomes in the long-term.
참고문헌 (24)
- Abdelaal MS, "Global perspectives on arthroplasty of hip and knee joints", Orthop Clin North Am, 51(2), pp.169~176 (2020)[DOI]
- Losina E, "The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic", J Bone Joint Surg Am, 94(3), pp.201~207 (2012)[DOI]
- Kurtz SM, "Future clinical and economic impact of revision total hip and knee arthroplasty", J Bone Joint Surg Am, 89(Suppl 3), pp.144~151 (2007)
- Ponzio DY, "Metaphyseal bone loss in revision knee arthroplasty", Curr Rev Musculoskelet Med, 8(4), pp.361~367 (2015)[DOI]
- Mancuso F, "Management of metaphyseal bone loss in revision knee arthroplasty", Acta Bio-med :Atenei Parmensis, 88(2S), pp.98~111 (2017)[DOI]
- Lei P-F, "Bone defects in revision total knee arthroplasty and management", Orthop Surg, 11(1), pp.15~24 (2019)[DOI]
- Sandiford NA, "No difference between trabecular metal cones and femoral head allografts in revision TKA : minimum 5-year followup", Clin Orthop Relat Res, 475(1), pp.118~124 (2017)[DOI]
- Jensen CL, "Outcome of revision total knee arthroplasty with the use of trabecular metal cone for reconstruction of severe bone loss at the proximal tibia", Knee, 21(6), pp.1233~1237 (2014)[DOI]
- De Martino I, "Tantalum cones provide durable mid-term fixation in revision TKA", Clin Orthop Relat Res, 473(10), pp.3176~3182 (2015)[DOI]
- Thorsell M, "Good clinical and radiographic outcome of cementless metal metaphyseal sleeves in total knee arthroplasty", Acta Orthop, 89(1), pp.84~88 (2018)[DOI]
- Fedorka CJ, "Revision total knee arthroplasty with porous-coated metaphyseal sleeves provides radiographic ingrowth and stable fixation", Knee Surg Sports Traumatol Arthrosc, 26(5), pp.1500~1505 (2018)[DOI]
- Barnett SL, "Use of stepped porous titanium metaphyseal sleeves for tibial defects in revision total knee arthroplasty : short term results", J Arthroplast, 29(6), pp.1219~1224 (2014)[DOI]
- Bugler KE, "Metaphyseal sleeves for revision total knee arthroplasty : good short-term outcomes", J Arthroplast, 30(11), pp.1990~1994 (2015)[DOI]
- Chalmers BP, "Survivorship of metaphyseal sleeves in revision total knee arthroplasty", J Arthroplast, 32(5), pp.1565~1570 (2017)[DOI]
- Martin-Hernandez C, "Midterm results for metaphyseal sleeves in revision knee surgery", Knee Surg Sports Traumatol, Arthrosc, 25(12), pp.3779~3785 (2017)[DOI]
- Watters TS, "Porouscoated metaphyseal sleeves for severe femoral and tibial bone loss in revision TKA", J Arthroplast, 32(11), pp.3468~3473 (2017)[DOI]
- Scuderi GR, "The New Knee Society Knee Scoring System", Clin Orthop Relat Res, 47(1), pp.3~19 (2012)[DOI]
- Engh GA, "Bone loss with revision total knee arthroplasty : defect classification and alternatives for reconstruction", Instr Course Lect, 48, pp.167~175 (1999)
- Ewald FC, "The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system", Clin Orthop Relat Res, 248, pp.9~12 (1989)
- Angerame MR, "Management of bone defects in revision total knee arthroplasty with use of a stepped, porous-coated metaphyseal sleeve", JBJS Essent Surg Tech, 9(2), pp.e14~ (2019)[DOI]
- Huang R, "Revision total knee arthroplasty using metaphyseal sleeves at short-term follow-up", Orthopedics, 37(9), pp.e804~e809 (2014)[DOI]
- Tommaso Bonanzinga, "Are Metaphyseal Sleeves a Viable Option to Treat Bone Defect during Revision Total Knee Arthroplasty? A Systematic Review", Joints, 07(01), pp.019~024 (2019), Georg Thieme Verlag KG[DOI]
- Mutsuzaki H, "Target range of motion for rehabilitation after total knee arthroplasty", J Rural Med, 12(1), pp.33~37 (2017)[DOI]
- Alexander GE, "Cementless metaphyseal sleeves used for large tibial defects in revision total knee arthroplasty", J Arthroplast, 28(4), pp.604~607 (2013)[DOI]