2025 SICOT Annual Meeting: Metaphyseal Fixation In Revision Total Knee Arthroplasty: A Systematic Review And Meta-Analysis Of Cones And Sleeves

Thirty-one studies with 2,574 revision total knee arthroplasties (1,637 with cones and 937 with sleeves) were included in this systematic review and meta-analysis comparing metaphyseal cones versus sleeves. Pooled outcomes of interest included re-revision rate, re-operation risk, prosthetic joint infection, and extensor mechanism injury. Cones showed higher rates of re-revision (10.9% vs. 7.4%), re-operation (17.5% vs. 12.2%), and prosthetic joint infection (7.5% vs. 5%) compared to sleeves. Extensor mechanism injury was rare but slightly more frequent with cones. Overall, sleeves demonstrated lower failure and complication rates, suggesting they may offer a modest advantage over cones in revision TKA.