Metaphyseal cones and sleeves in revision total knee arthroplasty: Two sides of the same coin? Complications, clinical and radiological results—a systematic review of the literature

  • A. ZaniratoEmail author
  • M. Formica
  • L. Cavagnaro
  • S. Divano
  • G. Burastero
  • L. Felli


Revision total knee arthroplasty (rTKA) is increasing of relevance in orthopaedic surgeon daily practice and this trend is likely to continue in the years ahead. The aim of this systematic review of English literature is to summarize and compare indications, complications, clinical and radiological results of metaphyseal cones and sleeves in management of bone loss in rTKA. Retrospective or prospective studies with at least 1 year of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Clinical and radiological results, rates of intraoperative fractures, aseptic loosening, periprosthetic joint infection, septic failure, reoperations and re-revisions were extrapolated by the papers. Thirty-seven articles were included in the systematic review. Results of 927 cones (mean FU of 3.6 ± 1.4 years) and 1801 sleeves (mean FU of 4.5 ± 1.6 years) were analysed. The studies showed good clinical and functional outcomes. Cones and sleeves allowed a stable metaphyseal fixation. The aseptic survivorship of the implants was 97.3% in cones group and 97.8% in sleeves group. Metaphyseal cones and sleeves represent a viable option in management of type IIb and III AORI bone defects in aseptic and septic TKAr with overlapping survival rate. Further high-quality long-term studies would better clarify complications, clinical and radiological results of these promising techniques in revision total knee arthroplasty.


Revision total knee arthroplasty Bone defect Metaphyseal sleeves Metaphyseal cones Results Complications 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Istituto Ortopedico Rizzoli 2019

Authors and Affiliations

  • A. Zanirato
    • 1
    Email author
  • M. Formica
    • 1
  • L. Cavagnaro
    • 2
  • S. Divano
    • 1
  • G. Burastero
    • 2
  • L. Felli
    • 1
  1. 1.Clinica Ortopedica - Ospedale Policlinico San MartinoGenoaItaly
  2. 2.Ortopedia e Traumatologia 2 – Joint Replacement Unit – Ospedale Santa CoronaPietra LigureItaly

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