Abstract
Bone loss often complicates revision total knee arthroplasty (TKA). Management of
metaphyseal defects varies, with no clearly superior technique. Two commonly utilized
options for metaphyseal defect management include porous-coated metaphyseal sleeves
and tantalum cones. A systematic review was conducted according to the international
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
We combined search terms “Total knee arthroplasty” AND/OR “Sleeve,” “Cone” as either
keywords or medical subject heading (MeSH) terms in multiple databases according to
PRISMA recommendations. All retrieved articles were reviewed and assessed using defined
inclusion and exclusion criteria. A total of 27 studies (12 sleeves and 15 cones)
of revision TKAs were included. In the 12 studies on sleeve implantation in revision
TKAs, 1,617 sleeves were implanted in 1,133 revision TKAs in 1,025 patients. The overall
rate of reoperation was 110/1,133 (9.7%) and the total rate of aseptic loosening per
sleeve was 13/1,617 (0.8%). In the 15 studies on tantalum cone implantation in revision
TKAs, 701 cones were implanted into 620 revision TKAs in 612 patients. The overall
rate of reoperation was 116/620 (18.7%), and the overall rate of aseptic loosening
per cone was 12/701 (1.7%). Rates of aseptic loosening of the two implants were found
to be similar, while the rate of reoperation was nearly double in revision TKAs utilizing
tantalum cones. Variability in the selected studies and the likely multifactorial
nature of failure do not allow for any definitive conclusions to be made. This review
elucidates the necessity for additional literature examining revision TKA implants.
Keywords
total knee arthroplasty - total knee arthroplasty revision - metaphyseal sleeve -
tantalum cone
