Metaphyseal Cones and Sleeves in Revision Total Knee Arthroplasty

The volume of revision total knee arthroplasties (TKAs) is expected to increase significantly over the next 10 years. Obtaining stable and durable implant fixation in the face of bone loss is of paramount importance to the success of revision TKAs. Metaphyseal cones and sleeves made of porous biomaterials such as 3D-printed titanium and tantalum allow for durable biologic fixation and address bone loss. Generally, cones may be prepared and implanted separately and are often independent of a particular manufacturer or knee system, whereas metaphyseal sleeves are unique to a manufacturer and are modular in nature (like the prosthesis). Both cones and sleeves may be used with cemented or uncemented stems. Mid-term data on clinical and radiographic outcomes of porous metaphyseal cones and sleeves are promising, with survivorship free of aseptic loosening of 95–100%.