title: Cementless metaphyseal sleeves without stem in revision total knee arthroplasty.
abstract: BACKGROUND
  Revision total knee arthroplasty with a cementless metaphyseal sleeve is suggested to be used without stem in revision total knee arthroplasty (rTKA). To the best of our knowledge, no papers investigating this have been published. The purpose of this study was to evaluate clinical outcome.
  
  
  METHODS
  In this retrospective study, 71 patients operated with rTKA with sleeves without stem in the period 2009-2011 were identified; 63 were examined. All patients with the prosthesis still in place were invited to a medical examination including X-rays. American Knee Society Score (AKSS) and Oxford Knee Score (OKS) were used as primary clinical outcome scores.
  
  
  RESULTS
  Mean number of revisions including the revision with sleeve was 1.7. AKSS increased significantly from 62.7 to 109.6; (p value <0.0001). The overall satisfaction was 2.5 on a four-stage scale, going from very satisfied to dissatisfied (range 1-4). The Anderson Orthopaedic Research Institute (AORI) classification showed 63 % of the tibias and 56 % of the femurs to be type 2B, whereas 19 % tibias and 5 % femurs were type 3. Review of the X-rays showed all prostheses fixed. Mean tibiofemoral alignment was 6.0° valgus, and 51 % were outside optimal alignment (2.4°-7.2°). Six patients were excluded from the study.
  
  
  CONCLUSIONS
  We found that the prostheses were overall well fixed and patients' AKSS increased significantly. Many patients had pain conditions, both comorbid pain and pain that might be alignment-related, and adding a stem thus seems to be a good idea in terms of alignment. Level of evidence Level IV, case series without control group.
authors.affiliation: Department of Orthopaedic Surgery, Herlev og Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Gentofte, 2900, Denmark. dgmadsen@gmail.com.|Department of Orthopaedic Surgery, Herlev og Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark. dgmadsen@gmail.com.
authors.forename: David
authors.identifier: http://orcid.org/0000-0001-7138-6340
authors.initials: D
authors.lastname: Gøttsche
authors.affiliation: Department of Orthopaedic Surgery, Herlev og Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Gentofte, 2900, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lind
authors.affiliation: Department of Orthopaedic Surgery, Herlev og Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Gentofte, 2900, Denmark.
authors.forename: Thorbjørn
authors.initials: T
authors.lastname: Christiansen
authors.affiliation: Department of Orthopaedic Surgery, Herlev og Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Gentofte, 2900, Denmark.|Department of Orthopaedic Surgery, Næstved Sygehus, Ringstedgade 61, 4700, Næstved, Denmark.
authors.forename: Henrik M
authors.initials: HM
authors.lastname: Schrøder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001843:Bone Cements; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery
chemical_list: D001843:Bone Cements
keywords: AKSS; AORI classification; Cementless porous metaphyseal sleeves; Oxford Knee Score; Revision total knee arthroplasty; rTKA