Intermediate-Term Survivorship of Metaphyseal Cones and Sleeves in Revision Total Knee Arthroplasty

Background: Both cones or sleeves have been developed to address metaphyseal bone loss in revision total knee arthroplasty (TKA), but few studies have directly compared the outcomes. The purpose of this study was to compare the survivorship and aseptic revision rates between metaphyseal cones and sleeves at intermediate follow-up. Methods: We reviewed a consecutive series of 1,172 revision TKA patients between 2009 and 2018 with a minimum two-year follow-up on all patients. We compared demographics, surgical indication, stem fixation, constraint, rates of rerevision, and Short-Form-12 scores between patients with cones and sleeves. A multivariate analysis was performed to identify the effect of cones and sleeves on aseptic rerevision. Kaplan-Meier curves were generated to compare aseptic survivorship of cones and sleeves. Results: There were 194 tibial cones (17%), 107 tibial sleeves (9%), 31 femoral cones (3%), and 135 femoral sleeves (12%) with a mean follow-up of 6.5 years (range: 2-12 years). There was no difference in demographics, indication, stem fixation, or constraint (P > .05). Although overall aseptic failure rates may be lower for tibial sleeves, there were no significant differences in survivorship over a one-year, two-year, and five-year follow-up when both tibial and femoral sleeves were directly compared to cones. Conclusion: Both tibial and femoral sleeves and cones perform well at an intermediate-term follow-up. Further investigation of these two are required to better understand their survivorship relative to each other.