STR TRUC UCTUR TURAL B L BONE ONE ALLOGR LLOGRAFT FT HAS B S BEEN EEN REPLA LACED B BY Y MOD MODULA ULAR ME META TAPHYS HYSEAL L SLE LEEVES IN IN REVI VISION ON TK TKA Douglas A. Dennis, M.D. Adjunct Professor, Dept. of Biomedical Engineering, University of Tennessee Adjunct Professor of Bioengineering University of Denver Assistant Clinical Professor, Dept. of Orthopedics University of Colorado School of Medicine
DISCLO DISCLOSURE Cons onsult ultan ant : t : Depuy puy Roy oyalt alties ies: : • Depuy uy / / Innom nnomed ed / / Wolt olter ers K Kluw uwer Labo borato atory R Resear earch ch S Suppo pport rt • Depuy uy • Por Porter er A Adven entis ist H t Hosp ospit ital al Owner ership I hip Int nteres erest: t: J Joint int Vue ue
REVISI REVISION ON TK TKA: A: Fix Fixat ation Op ion Options ions Thre Three Zone Zones Of Fixation ation 2. • 1. 1. Cond Condyles les 1. • 2. 2. Metap taphysi ysis • 3. 3. Diap Diaphy hysis is
LA LARGE GE TYPE 2B 2B & & 3 3 DE DEFE FECT CTS Wha What To t To Do o ? ↓ Condyl ondylar S Suppor upport Fi Fixa xati tion on Compr ompromi omise sed ↑ Str tress sses On s On Ste tems ms
REVISI REVISION ON TK TKA: A: Fix Fixat ation Op ion Options ions Metaph taphyseal F eal Fixat ation ion • Metap aphy hyseal Sleev l Sleeves Or Or C Cones ones
METAPHY APHYSEA SEAL S L SLEEV EVES ES Me Meta taphys hyseal Augme ugment ntati tions ons • Fem emoral l & Tibial D ial Defec fects • Ste Step D Des esig ign – Prog ogressi ssive ve Metap taphyseal al Loa oadi ding – + Bone one R Respo ponse se • Pr Precis ecise B e Bone Pr Prep eparatio ion – Metap taphyseal al Broa oachi hing ng
METAPH PHYSEA SEAL S SLEEVES EVES Vario Various Si Size zes Fem emoral & l & Tibial ial Ma Mate Wi With A Any Le ny Level Of Of Const straint PS → VVC → Hin • PS inge
FEMO FEMORAL SLE L SLEEVES Pa Part rtial O ial Or Full Po l Poro rous Coat atin ing Modular S ar Stem A m Attach tachmen ment t (Reco commen mended ed)
SURG SURGICA CAL T TECH ECHNIQUE Ream IM m IM Cana nal • Han and O Or Po Power wer • Determ termines es S Stem D m Diameter eter Broa oach Me h Meta taphys hysis • ⇧ Si Size ze U Until il Rigid id F Fixat atio ion Re Resect ect Art Artic icula lar Surface rface Gr Graft C t Cavi vita tary D y Defects ts
TIBI TIBIAL CUT O CUT OFF BRO FF BROACH
METAPHY APHYSEA SEAL S L SLEEV EVES ES
FE FEMOR MORAL S L SLE LEEVES Pr Provid ide F Fixat atio ion & & C Chosen en Siz ize Det e Determines Jo Joint Lin ine ⇧ Size = = Mor More D Dist stal Joi oint Li Line • Init itia ially lly I Inser ert Sma Smalle ller Sleev Sl eve e / Bone R Resec ectio ions • Trial al R Reducti ction / / Determ termine e Desir ire J Join int L Lin ine L Lev evel el • Larg arger Sl Sleev eve e To G Gain R Rigid id Fix ixation & & Des Desired Jo Joint Lin ine
HEMA HEMATOGEN ENOUS MSSA S MSSA: 2 2-STA TAGE
REIMPL MPLANTI ANTION: S SLEE EEVES
METAPH PHYSEA SEAL S SLEEVES EVES Help elpfu ful I l In Cases es Req equirin iring C Corr rrectiv ive e Distal F al Fem emoral O l Osteo teotomy Add dditional Fi Fixation / / Bridges Ost s Osteotomy
METAPH PHYSEA SEAL S SLEEVES EVES
78 ⧬ 18 Months S Months S/P /P OR ORIF Inte IF Intercond ondyl ylar Fx Fx Nonuni Nonunion on / / Sagi gitta ttal S Spl plit
2 Year ears S/ S/P P Distal F l Fem em. Repla lacement W With Sl Sleev eve Note Sl Sleev eve e Trab rabeculat latio ion Courtesy J sy James s Dow owd, MD MD
METAPHY APHYSEA SEAL S L SLEEV EVES ES Watte tters, Denni nnis, et al l J Arthr throplas asty ty 2017 17 116 R Revi visi sion TK TKA 152 52 Metaphysea eal Sl l Sleev eves es • 41 F 1 Fem emoral / l / 111 11 Tibial al Mean an F F/U D Dura ratio ion: 5 5.3 Y 3 Year ears • 2 2 – 9.6 Y 6 Year ears Type pe 2 2A - Femur ur 3 Type pe 2 2B - Femur ur 34 Type pe 3 3 - Femur ur 4 Type pe 2 2A - Ti Tibia 5 Type pe 2 2B - Ti Tibia 89 Type pe 3 3 - Ti Tibia 17
RESU RESULTS Sle leeve e Surviv ivorshi hip Curve 1 97.8% Survivorship @ 5.3 Yrs Percent Not Revised Survivorship - All Cause Revision of 0.95 Metaphyseal Sleeve Revision for Asceptic Loosening of Metaphyseal Sleeve 0.9 0 12 24 36 48 60 Time (months)
SUMMA SUMMARY Me Meta taphys hyseal Fi Fixa xati tion on Of Offers Addi dditi tiona onal Enha nhanc nceme ments In ts In Prosthe osthesi sis Fi s Fixa xati tion on • La Large ge Type Type 2 2B & & 3 Defects ts Me Meta taphys hyseal S Sleeves • Pre recis cise Bo e Bone Pre repar aratio ation e ↑ Fi • Immediat iate Fixa xati tion on • Reliabl ble Fi Fixa xati tion on In In Compl omplex Fi x Fixa xati tion on Case ses
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