At the 23rd Annual Meeting of the American Association of Hip and Knee Surgeons in Dallas, Texas, November 8-10, 2013, Dr. Patel, Dr. Barnett, Dr. Gorab, and Dr. Gondusky presented results of a multicenter study using cementless metaphyseal sleeves for fixation in the femur and tibia (thigh bone and shin bone) of patients who were undergoing revision knee replacement. They found that this type of combined cementless sleeve in association with cemented components provided good short-term outcome and made the feeling of bony defects easier.
In a study reported by Dr. Dalury from Baltimore, Maryland and myself, we found a similar outcome in over 70 cases of revision total knee. The use of these cementless cones in the end of the femur and top of the shin bone facilitate filling of defects often encountered at the time of revision knee replacement. These cones are attached to femoral and tibial components that are cemented to the surface of the bones. In this fashion, a combination of cemented and cementless fixation can be used in these challenging revision total knee cases. Long-term followup is required to conclude whether or not this is a preferred way, but in the short run appears to be a better way of dealing with failed total knee replacements.