CONSERVATION REVISION OF TKA ALONG WITH METAPHYSEAL METAL DEVICES SLEEVES AND CONES

Objective: Revision total knee arthroplasty is always required after knee periprosthetic fractures and implant loosening. There are many renovation choices available. The aim of our study is to report on conservative renovation option, revision TKA along with metaphyseal sleeves or cone. Method: We assessed 22 patients who gone through revision TKA along with a metaphyseal sleeve or porous cone between January 2017 and December 2019. Patients were followed up to period of two years. Patients were evaluated using The Knee Society score at each follow-up. X-rays  were taken at 6 weeks, 3 months, and final visit. Results: From 22 patients, 16 were belonging to female group and the rest 6 were identified from the male group. The mean age of patients was 66.95±11.45 years ranging from 46-85 years. Majority of patients were females (72.7%). Preoperatively periprosthetic fracture after TKA  was diagnosed in 12 patients (54.4%) followed by 5 loosening of prosthesis after primary TKA (22.8%), 4 patients with infection(18.16%) and 1 periprosthetic pain after TKA (4.54%). The mean follow-up was 18 months ranging from 3-35 months.  The mean of knee society score was improved from 35 points which range from (10 – 68) preoperatively to 85(range 50-90) at six week and 90 (range 40-100) at final follow up. The mean Knee Society function scores increased from 25 (range 10- 65) preoperatively to 62 (range 36–100) postoperatively. The average flexion contracture was 6° (range 0°–30°) preoperatively and at the time of the latest follow-up, the average flexion contracture was 3° (range 0°–15°) .Mean range of motion was 120°  (range 80° to 135°) preoperatively and 115°(range 95° to 140°) post operatively.. There was no significant (p>0.05) correlation of scores with follow-up time. Conclusion: From all the outcomes we reached to the conclusion that both cones and sleeves are feasible and executable option for a stable reconstruction of revision TKA  after periprosthetic fractures and for aseptic loosening cases with AORI defined type 1, type II and type III bone defects.