PAPER R. MORGAN-JONES
Zonal Fixation in revision total knee arthroplasty

Zonal fixation in revision total knee arthroplasty R Morgan-Jones1 , S I S Oussedik2 , H Graichen3 , F S Haddad4 Affiliations

PMID: 25628273 DOI: 10.1302/0301-620X.97B2.34144

Abstract
Revision knee arthroplasty presents a number of challenges, not least of which is obtaining solid primary fixation of implants into host bone. Three anatomical zones exist within both femur and tibia which can be used to support revision implants. These consist of the joint surface or epiphysis, the metaphysis and the diaphysis. The methods by which fixation in each zone can be obtained are discussed. The authors suggest that solid fixation should be obtained in at least two of the three zones and emphasise the importance of pre-operative planning and implant selection.

Keywords: Multi-zone strategy; Revision total knee replacement; Zonal fixation.

 

©2015 The British Editorial Society of Bone & Joint Surgery.

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METAPHYSEAL CONES AND SLEEVES IN REVISION TOTAL KNEE ARTHROPLASTY: TWO SIDES OF THE SAME COIN?

Complications, clinical and radiological results—a systematic review of the literature A. Zanirato1 · M. Formica1 · L. Cavagnaro2 ·
S. Divano1 · G. Burastero2 · L. Felli1 Received: 10 December 2018 / Accepted: 8 February 2019 © Istituto Ortopedico Rizzoli
2019

Abstract
Revision total knee arthroplasty (rTKA) is increasing of relevance in orthopaedic surgeon daily practice and this trend is likely to continue in the years ahead. The aim of this systematic review of English literature is to summarize and compare indications, complications, clinical and radiological results of metaphyseal cones and sleeves in management of bone loss in rTKA. Retrospective or prospective studies with at least 1 year of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Clinical and radiological results, rates of intraoperative fractures, aseptic loosening, periprosthetic joint infection, septic failure, reoperations and re-revisions were extrapolated by the papers. Thirty-seven articles were included in the systematic review. Results of 927 cones (mean FU of 3.6 ± 1.4 years) and 1801 sleeves (mean FU of 4.5 ± 1.6 years) were analysed. The studies showed good clinical and functional outcomes. Cones and sleeves allowed a stable metaphyseal fixation. The aseptic survivorship of the implants was 97.3% in cones group and 97.8% in sleeves group. Metaphyseal cones and sleeves represent a viable option in management f type IIb and III AORI bone defects in aseptic and septic TKAr with overlapping survival rate. Further high-quality long-term studies would better clarify complications, clinical and radiological results of these promising techniques in revision total knee arthroplasty.

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