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      Metaphyseal sleeves in arthroplasty of the knee : A suitable tool in management of major metaphyseal bone loss Translated title: Metaphysäre Sleeves in der Kniegelenkendoprothetik : Ein geeignetes Instrument für die Behandlung eines schweren metaphysären Knochenverlusts


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          This study examined the clinical outcome following revision arthroplasty of the knee joint and severe arthrosis with metaphyseal bone defects and instability using metaphyseal sleeves. We analyzed the results based on established scores and recorded the complications occurring on revision arthroplasty.

          Material and methods

          Patients with revision arthroplasty of the knee and metaphyseal bone defects grade III according to the Anderson Orthopedic Research Institute (AORI) classification were included (16 patients, 9 females and 7 males). In all cases, surgery was performed using an endoprosthesis COMPLETE™ revision knee system with metaphyseal sleeves.


          All patients had a significant reduction in pain level after revision surgery. The median HSS score in the cohort with primary arthroplasty was 84 and in the cohort with revision arthroplasty 73 and the KSS was 83 and 55, respectively. According to the HSS an excellent result was achieved by 50% of the patients in the primary arthroplasty group and 25% in the revision group. Only three patients were considered to have an insufficient result. Postoperative pain was significantly reduced in both groups. The median ROM was 112° flexion in the primary arthroplasty group and 95° in the revision group. An extension deficit was observed in three patients and four patients showed prolonged wound healing postoperatively (25%), which was treated conservatively and did not lead to septic changes.


          The use of metaphyseal sleeves in patients with bone defects is a suitable instrument with no negative impact on the outcome both in primary and revision arthroplasty. Further studies with larger study groups and analysis of long-term results after use of such endoprosthetic components should be conducted.

          Translated abstract


          Diese Arbeit untersucht das klinische Ergebnis nach Verwendung sog. Sleeves (Hülsen) in der aseptischen Revisionsendoprothetik des Kniegelenks sowie bei schwerster Arthrose mit metaphysären Knochendefekten und Instabilität. Die Ergebnisse wurden auf der Grundlage etablierter Scores analysiert und die aufgetretenen Komplikationen erfasst.

          Material und Methoden

          Es wurden Patienten mit Revisionsendoprothesen des Knies und metaphysären Knochendefekten mit einem Klassifizierungsgrad III nach dem Anderson Orthopedic Research Institute (AORI) eingeschlossen (16 Patienten; 9 weiblich und 7 männlich). In allen Fällen wurde die Operation mit dem Endoprothesen-Revisionssystem COMPLETE™ mit metaphysären Sleeves durchgeführt.


          Bei allen Patienten konnte eine signifikante Reduktion der Schmerzen durch die Revisionsoperation erzielt werden. Der Medianwert des HSS-Scores lag bei 84 in der Gruppe der primär Operierten und bei 73 in der Gruppe mit Voroperationen, der Wert des KSS-Scores betrug 83 bzw. 55. Entsprechend des HSS-Scores erhielten 50 % der Patientengruppe der Erstoperierten ein „ausgezeichnetes“ Ergebnis und 25 % in der Revisionsgruppe. Nur 3 Patienten wurden insgesamt als „unzureichend“ eingestuft. Die postoperativen Schmerzen waren im Vergleich zu den präoperativen in beiden Gruppen signifikant reduziert. Der mediane Bewegungsumfang (ROM) betrug 112° Beugung in der primär operierten Gruppe bzw. 95° in der Revisionsgruppe. Bei 3 Patienten wurde ein Extensionsdefizit beobachtet und 4 Patienten zeigten postoperativ eine prolongierte Wundheilung (25 %), die konservativ behandelt wurde und nicht zu septischen Revisionseingriffen führte.


          Metaphysären Sleeves stellen bei Patienten mit Knochendefekten ein geeignetes Instrument dar, das sowohl bei Primäreingriffen als auch bei Revisionsoperationen nicht zu unterlegenen Ergebnissen bei Patienten mit schweren metaphysären knöchernen Defekten führt. Weitere Studien mit größeren Studiengruppen und die Analyse der Langzeitergebnisse nach dem Einsatz solcher endoprothetischer Komponenten sollten durchgeführt werden.

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          Most cited references26

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          Radiological assessment of osteo-arthrosis.

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            Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030

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              The Epidemiology of Revision Total Knee Arthroplasty in the United States

              Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed. Level of Evidence: Level II, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.

                Author and article information

                Der Orthopade
                Springer Medizin (Heidelberg )
                21 October 2020
                21 October 2020
                : 50
                : 9
                : 750-757
                [1 ]GRID grid.411339.d, ISNI 0000 0000 8517 9062, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, , Universitätsklinikum Leipzig, ; Liebigstr. 20, 04103 Leipzig, Germany
                [2 ]Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
                © The Author(s) 2020

                Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                Funded by: Universitätsklinikum Leipzig (8929)
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                retrospective study,revision arthroplasty,osteoarthritis, knee,complications,aseptic loosening,retrospektive studie,revisionsarthroplastik,gonarthrose,komplikationen,aseptische lockerung


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