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Purpose  The aim of this study was to evaluate the efficacy in terms of clinical results and radiographic findings of using metaphyseal sleeves in revision total knee arthroplasty (TKA), and to check if the use of sleeves without stems did not impair such results. Methods  In this retrospective study, 141 patients (143 knees) operated in the period 2008 to 2015 met the above-mentioned criteria and were invited to a medical examination including X-rays. A total of 121 knees were available for the study (44 in the group without stems and 77 in the group with stems). Mean follow-up was 63 months for the stemless group and 89 for the group with stems. Knee Society Score (KSS) (objective knee score) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used as outcome scores and compared with baseline values, range of motion (ROM) was also compared with preop value and X-rays were also examined and compared with immediate postop X-rays to check signs of loosening and radiolucent lines, if any, and bone ingrowth. Satisfaction of the patients was also investigated using a linear scale from 1 to 10. Results  KSS improved from 34 to 81 postop (39 to 81 in the stemless group) ( p  < 0.01), while WOMAC from 82% preop to 39% postop (76 to 37% in the stemless group) ( p  < 0.01). Forty-six patients were satisfied, 20 partially satisfied, and 11 unsatisfied (respectively 25-14-5 in the stemless group). ROM improved from 89 degrees preop to 99 degrees postop (93 to 98 degrees in the stemless group). X-rays showed no loosening of the implant, radiolucent lines in 8 patients, and bone ingrowth in 113 out of 121 patients. Conclusion  In this midterm follow-up study, we found a significant improvement in clinical results compared with preop values. We found no difference between the two groups (with and without stems) thus suggesting that the use of stemless sleeves does not impair results in revision TKA. Level of Evidence  Therapeutic case series, level IV., Competing Interests: Conflict of Interest G.S. is a paid consultant of DePuy Synthes., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Purpose  The aim of this study was to evaluate the efficacy of revision total knee arthroplasty (TKA) with cementless metaphyseal sleeves without stems either in the femoral or tibial side or in both. Methods  In this retrospective study, 51 patients (51 knees) operated in the period 2010 to 2015 met the above-mentioned criteria and were invited to a medical examination including X-rays. Forty-six were available for the study. Mean follow-up was 37 months. Knee Society score (KSS) (objective knee score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and range of motion (ROM) were used as outcome scores and compared with baseline values. X-rays were also examined and compared with postoperative exams to evaluate the presence of loosening, radiolucent lines, and bone ingrowth. Satisfaction of the patients was also investigated using a linear scale from 1 to 10. Results  KSS improved from 39 to 77 ( p  < 0.01); WOMAC score improved from 76 to 41 ( p  < 0.01). Twenty-four (52%) patients were satisfied, 15 (32%) were partially satisfied, and 7 (16%) were unsatisfied. ROM improved from 93 to 96 degrees (nonsignificant difference). X-rays showed no loosening of the implants, radiolucent lines in 4 patients (3 of them were asymptomatic) and bone ingrowth in 43 out of 46 patients. Conclusion  In this short-term retrospective study, the use of sleeves without stem was a safe and effective procedure in revision TKA. We found a significant improvement in clinical results compared with baseline values and no signs of implant loosening. Level of Evidence  Level IV, therapeutic case series.

Unlabelled: The use of tissue engineering for cartilage repair has emerged as a potential therapeutic option and has led to the development of Hyalograft C, a tissue-engineered graft composed of autologous chondrocytes grown on a scaffold entirely made of HYAFF 11, an esterified derivative of hyaluronic acid. Here we present the results of an ongoing multicenter clinical study conducted with the primary objective to investigate the subjective symptomatic, functional and health-related quality of life outcomes of patients treated with Hyalograft C. Clinical results on the cohort of 141 patients with followup assessments ranging from 2 to 5 years (average followup time: 38 months), are reported. At followup 91.5% of patients improved according to the International Knee Documentation Committee subjective evaluation; 76% and 88% of patients had no pain and mobility problems respectively assessed by the EuroQol-EQ5D measure. Furthermore, 95.7% of the patients had their treated knee normal or nearly normal as assessed by the surgeon; cartilage repair was graded arthroscopically as normal or nearly normal in 96.4% of the scored knees; the majority of the second-look biopsies of the grafted site histologically were assessed as hyaline-like. Importantly, a very limited complication rate was recorded in this study. The positive clinical results obtained indicate that Hyalograft C is a safe and effective therapeutic option for the treatment of articular cartilage lesions., Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.