Short-term results of metaphyseal sleeves in total knee arthroplasty for severe bone defects of the tibia.

Abstract

Severe bone defects pose a major challenge in total knee arthroplasty (TKA); however, metaphyseal sleeves may be a viable option to treat Anderson Orthopedic Research Institute (AORI) classification Type II bone defects. This study reports the short-term results of metaphyseal sleeves for severe bone defects in the proximal tibia. From 2013 to 2019, a total of 10 cases were treated at our hospital with metaphyseal sleeve implants (ATTUNE revision system; DePuy-Synthes MBT, Warsaw, IN, USA), of which 2 cases underwent primary TKA for severe varus deformity, 5 underwent revision, and 3 underwent re-revision. The mean age was 71.2 (57-81) years, and the mean observation period was 5.3 years. There were 5 cases of AORI Type IIa and 5 cases of Type IIb. The mean implant survival time was approximately 4.7 (3.0-6.2) years. There was one case that underwent revision surgery. One patient underwent arthrodesis after implant removal due to infection. The Knee Society score (KSS) was 75 (60-95) points preoperatively and 120 (90-145) points 12-months postoperatively. Excluding 2 cases that underwent revision surgery, no progression of the radiolucent zone, implant migration, or fracture was observed up to the final follow-up of at least 24-months postoperatively. Metaphyseal sleeves can potentially replace more invasive procedures if the severe defect has little effect on the medial collateral ligament or patellar tendon attachment site with no observable mediolateral instability.