Metaphyseal Implants in Revision Total Knee Arthroplasty

Description

The presentation, led by Mark Heidenreich from the London Health Sciences Center in Ontario, discusses the challenges of bone loss in revision total knee arthroplasty and the innovative solutions involving metaphyseal implants. He notes that successful implantation relies on achieving stability in three key anatomical zones: the joint surface, metaphysis, and diaphysis, with particular innovations focusing on the metaphyseal zone. The audience is informed about a significant rise in the utilization of metaphyseal cones and sleeves, supported by evidence of their effectiveness in dozens of studies.



During the study, 180 patients who underwent revision surgeries with these implants were reviewed, establishing a follow-up period of approximately 41 months. Common reasons for revision included chronic infections. The study specifically looked at the outcomes associated with 83 cones and 121 sleeves from various manufacturers. Findings indicated that cones were primarily used in type 2B bone loss, while sleeves dominated in type 3 cases. Post-operative radiographs revealed minimal complications with no signs of implant migration, suggesting the stability of these implants.



Survivorship rates were promising, with cone implants achieving an overall reoperation-free survival rate of 87%, while sleeves had a slightly lower survival rate of 86%. Despite limitations—such as the heterogeneous cohorts and a lack of a control group—the data indicated that these metaphyseal implants provide robust fixation throughout the revision procedures. He closed by asserting the overall effectiveness of these implants against joint infections, while noting the absence of aseptic loosening cases.

DOI: 10.1302/3114-220892

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