Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2022

Open Access 13-08-2021 | Bone Defect | KNEE

Cones and sleeves present good survival and clinical outcome in revision total knee arthroplasty: a meta-analysis

Authors: Laura Theresa Fischer, Markus Heinecke, Eric Röhner, Peter Schlattmann, Georg Matziolis

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2022

Login to get access

Abstract

Purpose

The fixation of revision total knee arthroplasties (rTKA) tends to be difficult, leading to a reduction in implant survival. One option for achieving a more stable anchorage is to use metaphyseal cones and sleeves. The objective of the present paper is to provide a current comparative meta-analysis on survival and clinical results of cones vs. sleeves, with a differentiation between the short- and long-term outcome.

Methods

A search of the literature was conducted systematically to include original papers from 2010 to June 2021. The following parameters were taken into account: revision for aseptic loosening, revision for any reason, periprosthetic joint infections (PJI), KSS as well as KSFS. Studies with a mean follow-up of at least 60 months were defined to be long-term follow-up studies (LT). All other studies were included in the short-term (ST) study analysis. A pooled incidence was used as a summary statistic using a random intercept logistic regression model.

Results

The present meta-analysis included 43 publications with 3008 rTKA. Of these, 23 publications with 1911 cases were allocated to the sleeve group (SG) and 20 papers with 1097 cases to the cone group (CG). CG showed overall numerically higher complication rates in short- and long-term follow-up, compared with SG. Aseptic loosening occurred at a rate of 0.4% in SG (LT) and 4.1% in CG (LT) (p = 0.09). Periprosthetic joint infection (PJI) was more frequent in the cone group (7% in ST and 11.7% in LT) than in the sleeve group (3.4% in ST and 4.9% in LT, p = 0.02 both). The total revision rate was 5.5% in SG (LT) and 14.4% in CG (LT) (p = 0.12). The clinical scores were also comparable between the two groups. Hinged prothesis were used more frequent in the cone group (ST p < 0.001; LT p = 0.10), whereas CC type protheses were used more frequently in the sleeve group (ST p < 0.001; LT p < 0.11).

Conclusions

This meta-analysis takes into account the longest follow-up periods covered to date. Both cones and sleeves represent a reliable fixation method in the case of severe bone loss in rTKA, although the higher rate of PJI after cone fixation remains a source of concern. A metaphyseal fixation of hinged implants should be taken into account.

Level of evidence

II (meta-analysis).
Literature
1.
Abdelaziz H, Jaramillo R, Gehrke T, Ohlmeier M, Citak M (2019) Clinical survivorship of aseptic revision total knee arthroplasty using hinged knees and tantalum cones at minimum 10-year follow-up. J Arthroplasty 34:3018–3022CrossRef
2.
Agarwal S, Azam A, Morgan-Jones R (2013) Metal metaphyseal sleeves in revision total knee replacement. Bone Joint J 95:1640–1644CrossRef
3.
Agarwal S, Neogi DS, Morgan-Jones R (2018) Metaphyseal sleeves in revision total knee arthroplasty: minimum seven-year follow-up study. Knee 25:1299–1307CrossRef
4.
Balduzzi S, Rücker G, Schwarzer G (2019) How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health 22:153–160CrossRef
5.
Bernatz JT, Brooks AE, Squire MW, Illgen RI II, Binkley NC, Anderson PA (2019) Osteoporosis is common and undertreated prior to total joint arthroplasty. J Arthroplasty 34:1347–1353CrossRef
6.
Bloch BV, Shannak OA, Palan J, Phillips JR, James PJ (2020) Metaphyseal sleeves in revision total knee arthroplasty provide reliable fixation and excellent medium to long-term implant survivorship. J Arthroplasty 35:495–499CrossRef
7.
Burastero G, Cavagnaro L, Chiarlone F, Alessio-Mazzola M, Carrega G, Felli L (2018) The use of tantalum metaphyseal cones for the management of severe bone defects in septic knee revision. J Arthroplasty 33:3739–3745CrossRef
8.
Chang CB, Kim TK, Kang YG, Seong SC, Kang S-B (2014) Prevalence of osteoporosis in female patients with advanced knee osteoarthritis undergoing total knee arthroplasty. J Kor Med Sci 29:1425–1431CrossRef
9.
De Martino I, De Santis V, Sculco PK, D’Apolito R, Assini JB, Gasparini G (2015) Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res 473:3176–3182CrossRef
10.
Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRef
11.
Engh GA (2006) Classification of bone defects femur and tibia. Springer, Knee arthroplasty handbook, pp 116–132
12.
13.
Gurel R, Morgan S, Elbaz E, Ashlenazi I, Snir N, Kadar A et al (2021) Mid-term clinical and radiographic outcomes of porous-coated metaphyseal sleeves used in revision total knee arthroplasty. Knee Surg Rel Res 33:1–6CrossRef
14.
15.
Hernandez NM, Hinton ZW, Wu CJ, Ryan SP, Bolognesi MP (2021) Mid-term results of tibial cones : reasonable survivorship but increased failure in those with significant bone loss and prior infection. Bone Joint J 103-B:158–164CrossRef
16.
Jasper L, Jones C, Mollins J, Pohar S, Beaupre L (2016) Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musc Disord 17:1–9CrossRef
17.
Kamath AF, Lewallen DG, Hanssen AD (2015) Porous tantalum metaphyseal cones for severe tibial bone loss in revision knee arthroplasty: a five to nine-year follow-up. JBJS 97:216–223CrossRef
18.
Kim HJ, Lee O-S, Lee SH, Lee YS (2018) Comparative analysis between cone and sleeve in managing severe bone defect during revision total knee arthroplasty: a systematic review and meta-analysis. J Knee Surg 31:677–685CrossRef
19.
Klasan A, Magill P, Frampton C, Zhu M, Young SW (2021) Factors predicting repeat revision and outcome after aseptic revision total knee arthroplasty: results from the New Zealand Joint Registry. Knee Surg Sports Traumatol Arthrosc 29:579–585CrossRef
20.
Levent A, Suero EM, Gehrke T, Bakhtiari IG, Citak M (2021) Risk factors for aseptic loosening in complex revision total knee arthroplasty using rotating hinge implants. Int Orthop 45:125–132CrossRef
21.
Martin-Hernandez C, Floria-Arnal LJ, Muniesa-Herrero MP, Espallargas-Donate T, Blanco-Llorca JA, Guillen-Soriano M et al (2017) Mid-term results for metaphyseal sleeves in revision knee surgery. Knee Surg Sports Traumatol Arthrosc 25:3779–3785CrossRef
22.
Morgan-Jones R, Oussedik S, Graichen H, Haddad F (2015) Zonal fixation in revision total knee arthroplasty. Bone Joint J 97:147–149CrossRef
23.
Panda I, Wakde O, Singh H, Rajgopal A (2018) Management of large bone defects around the knee using porous tantalum trabecular metal cones during complex primary and revision total knee arthroplasty. Paper presented at: Seminars in Arthroplasty 2018
24.
Panegrossi G, Ceretti M, Papalia M, Casella F, Favetti F, Falez F (2014) Bone loss management in total knee revision surgery. Int Orthop 38:419–427CrossRef
25.
Panesar K, Al-Mouazzen L, Nessa L, Jonas SC, Agarwal S, Morgan-Jones R (2021) Revision total knee arthroplasty using an uncemented metaphyseal sleeve, rotating hinge prosthesis: a case series of 99 patients. J Arthroplasty 36:2121–2125CrossRef
26.
Potter GD III, Abdel MP, Lewallen DG, Hanssen AD (2016) Midterm results of porous tantalum femoral cones in revision total knee arthroplasty. JBJS 98:1286–1291CrossRef
27.
28.
Rosso F, Cottino U, Dettoni F, Bruzzone M, Bonasia DE, Rossi R (2019) Revision total knee arthroplasty (TKA): mid-term outcomes and bone loss/quality evaluation and treatment. J Orthop Surg Res 14:280CrossRef
29.
Russell LA (2013) Osteoporosis and orthopedic surgery: effect of bone health on total joint arthroplasty outcome. Curr Rheumatol Reports 15:371CrossRef
30.
31.
Sculco PK, Abdel MP, Hanssen AD, Lewallen DG (2016) The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 98-B:120–124CrossRef
32.
Team RC (2013) R: a language and environment for statistical computing
33.
Watters TS, Martin JR, Levy DL, Yang CC, Kim RH, Dennis DA (2017) Porous-coated metaphyseal sleeves for severe femoral and tibial bone loss in revision TKA. J Arthroplasty 32:3468–3473CrossRef
34.
Metadata
Title
Cones and sleeves present good survival and clinical outcome in revision total knee arthroplasty: a meta-analysis
Authors
Laura Theresa Fischer
Markus Heinecke
Eric Röhner
Peter Schlattmann
Georg Matziolis
Publication date
13-08-2021
Publisher
Springer Berlin Heidelberg
Keyword
Bone Defect
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2022
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-021-06670-0

Other articles of this Issue 8/2022

Knee Surgery, Sports Traumatology, Arthroscopy 8/2022 Go to the issue

KNEE

Equal bony resection of distal and posterior femur will lead to flexion/extension gap inequality in robot-assisted cruciate-retaining TKA

Correction

Correction to: The evaluation of Rolimeter, KLT, KiRA and KT-1000 arthrometer in healthy individuals shows acceptable intra-rater but poor inter-rater reliability in the measurement of anterior tibial knee translation

KNEE

Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis

Correction

Correction to: Tendinopathy VISAs have expired—is it time for outcome renewals?

KNEE

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

KNEE

Improved accuracy and reproducibility of a novel CT-free robotic surgical assistant for medial unicompartmental knee arthroplasty compared to conventional instrumentation: a cadaveric study