Metaphyseal sleeves in total knee arthroplasty revision: complications, clinical and radiological results. A systematic review of the literature

Introduction: Total knee arthroplasty revision (TKAr) is increasing of relevance in orthopaedic surgeon daily practice and will become more and more relevant in the future. The aim of this study is to summarize indications, complications, clinical and radiological mid-term results of metaphyseal sleeves in management of bone defects in TKAr. Methods: A systematic review of English literature was performed on Medline. Retrospective or prospective studies with 2 years of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Rates of intraoperative fractures, aseptic loosening, periprosthetic joint infection (PJI), reoperations and re-revisions were extrapolated by the papers. Results: 13 articles with a level of evidence of IV were included in the systematic review. 1079 TKAr (1554 sleeves) with a mean FU of 4.0 \ub1 1.1 years were analysed. The studies showed good clinical and functional outcomes. Sleeves allowed a stable metaphyseal fixation and osseointegration with an implant and sleeves aseptic survival rate of 97.7 and 99.2%, respectively. The incidence of PJI was 2.7 \ub1 2.4%. The estimated rate of reoperations and re-revisions were 14.2 \ub1 9.2 and 7.1 \ub1 4.8%, respectively. Conclusion: Metaphyseal sleeves represent a viable option in management of types IIb and III AORI bone defects in TKAr. Further high-quality log-term studies would better clarify complications, clinical and radiological results of this promising technique in total knee arthroplasty revision