Metaphyseal sleeves for revision total knee arthroplasty for patients with bone cement allergy and minimal bone loss: a case series.

Abstract

When evaluating persistent knee inflammation following total knee arthroplasty (TKA), hypersensitivity to implant components should be considered once other causes have been excluded. Revision total knee arthroplasty (rTKA) in patients with bone cement hypersensitivity presents a unique challenge. This study reports on four patients with clinical failure of TKA, three with confirmed allergy to polymethyl methacrylate (PMMA) and one to benzoyl peroxide, as demonstrated by skin patch testing. All patients underwent rTKA using metaphyseal sleeves. In three cases, diaphyseal stems were also used. After a mean follow-up of 71.2 months, all patients experienced symptomatic improvement, with a mean increase in range of motion (ROM) of 12.5 degrees. There was a mean increase of 16, 75 points in Knee Society Score. None required additional surgery. In patients undergoing revision TKA due to confirmed allergy to bone cement and minimal bone loss, the use of metaphyseal sleeves-alone or in combination with stems-provides a viable cementless fixation strategy with promising mid-term outcomes.