PMID- 34389876
OWN - NLM
STAT- MEDLINE
DCOM- 20220726
LR  - 20220727
IS  - 1433-7347 (Electronic)
IS  - 0942-2056 (Print)
IS  - 0942-2056 (Linking)
VI  - 30
IP  - 8
DP  - 2022 Aug
TI  - Cones and sleeves present good survival and clinical outcome in revision total 
      knee arthroplasty: a meta-analysis.
PG  - 2824-2837
LID - 10.1007/s00167-021-06670-0 [doi]
AB  - PURPOSE: The fixation of revision total knee arthroplasties (rTKA) tends to be 
      difficult, leading to a reduction in implant survival. One option for achieving a 
      more stable anchorage is to use metaphyseal cones and sleeves. The objective of 
      the present paper is to provide a current comparative meta-analysis on survival 
      and clinical results of cones vs. sleeves, with a differentiation between the 
      short- and long-term outcome. METHODS: A search of the literature was conducted 
      systematically to include original papers from 2010 to June 2021. The following 
      parameters were taken into account: revision for aseptic loosening, revision for 
      any reason, periprosthetic joint infections (PJI), KSS as well as KSFS. Studies 
      with a mean follow-up of at least 60 months were defined to be long-term 
      follow-up studies (LT). All other studies were included in the short-term (ST) 
      study analysis. A pooled incidence was used as a summary statistic using a random 
      intercept logistic regression model. RESULTS: The present meta-analysis included 
      43 publications with 3008 rTKA. Of these, 23 publications with 1911 cases were 
      allocated to the sleeve group (SG) and 20 papers with 1097 cases to the cone 
      group (CG). CG showed overall numerically higher complication rates in short- and 
      long-term follow-up, compared with SG. Aseptic loosening occurred at a rate of 
      0.4% in SG (LT) and 4.1% in CG (LT) (p = 0.09). Periprosthetic joint infection 
      (PJI) was more frequent in the cone group (7% in ST and 11.7% in LT) than in the 
      sleeve group (3.4% in ST and 4.9% in LT, p = 0.02 both). The total revision rate 
      was 5.5% in SG (LT) and 14.4% in CG (LT) (p = 0.12). The clinical scores were 
      also comparable between the two groups. Hinged prothesis were used more frequent 
      in the cone group (ST p < 0.001; LT p = 0.10), whereas CC type protheses were 
      used more frequently in the sleeve group (ST p < 0.001; LT p < 0.11). 
      CONCLUSIONS: This meta-analysis takes into account the longest follow-up periods 
      covered to date. Both cones and sleeves represent a reliable fixation method in 
      the case of severe bone loss in rTKA, although the higher rate of PJI after cone 
      fixation remains a source of concern. A metaphyseal fixation of hinged implants 
      should be taken into account. LEVEL OF EVIDENCE: II (meta-analysis).
CI  - (c) 2021. The Author(s).
FAU - Fischer, Laura Theresa
AU  - Fischer LT
AD  - Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the 
      University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany. 
      laurafischer95@googlemail.com.
FAU - Heinecke, Markus
AU  - Heinecke M
AD  - Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the 
      University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
FAU - Rohner, Eric
AU  - Rohner E
AD  - Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the 
      University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
FAU - Schlattmann, Peter
AU  - Schlattmann P
AD  - Department of Medical Statistics, Informatics and Data Science, Jena University 
      Hospital Jena, Bach Str. 18, 07743, Jena, Germany.
FAU - Matziolis, Georg
AU  - Matziolis G
AD  - Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the 
      University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20210813
PL  - Germany
TA  - Knee Surg Sports Traumatol Arthrosc
JT  - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
JID - 9314730
SB  - IM
MH  - *Arthritis, Infectious/surgery
MH  - *Arthroplasty, Replacement, Knee/adverse effects/methods
MH  - Humans
MH  - Knee Joint/surgery
MH  - *Knee Prosthesis/adverse effects
MH  - Prosthesis Design
MH  - Reoperation/methods
MH  - Retrospective Studies
PMC - PMC9309140
OTO - NOTNLM
OT  - Aseptic loosening
OT  - Bone defects
OT  - Cones
OT  - Revision total knee arthroplasty
OT  - Sleeves
OT  - Total knee replacement
COIS- The authors declare that they have no conflict of interest.
EDAT- 2021/08/15 06:00
MHDA- 2022/07/27 06:00
PMCR- 2021/08/13
CRDT- 2021/08/14 06:23
PHST- 2021/03/03 00:00 [received]
PHST- 2021/07/16 00:00 [accepted]
PHST- 2021/08/15 06:00 [pubmed]
PHST- 2022/07/27 06:00 [medline]
PHST- 2021/08/14 06:23 [entrez]
PHST- 2021/08/13 00:00 [pmc-release]
AID - 10.1007/s00167-021-06670-0 [pii]
AID - 6670 [pii]
AID - 10.1007/s00167-021-06670-0 [doi]
PST - ppublish
SO  - Knee Surg Sports Traumatol Arthrosc. 2022 Aug;30(8):2824-2837. doi: 
      10.1007/s00167-021-06670-0. Epub 2021 Aug 13.