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Scholarly Commons > HCA Healthcare Journal > Vol. 6 > Iss. 5 (2025)

 

Keywords

metaphyseal sleeves; knee injuries; total knee arthroplasty; TKA; arthroplasty; replacement; knee; posttraumatic arthritis; case reports

Disciplines

Orthopedics | Surgical Procedures, Operative

Abstract

Background

Total knee arthroplasty in younger patients presents a heightened risk of postoperative complications and implant failures compared to older populations, particularly in those with posttraumatic arthritis. These challenges necessitate careful consideration and specialized approaches to optimize the outcomes in this patient demographic.

Case Presentation

A 43-year-old man presented with left knee pain resulting from a traumatic lawn mower injury, causing an intraarticular distal femur, at the age of 6. The injury led to a limb-length discrepancy for which he underwent 2 limb-lengthening procedures in his early 20s. Radiographs demonstrated advanced posttraumatic osteoarthritis, and the patient elected to proceed with surgical intervention. Intraoperatively, significant deficiencies of the medial femur and anterodistal femur were noted, making cement, a bone graft, or a combination of both, less viable options. He underwent a left total knee arthroplasty, with the utilization of a femoral metaphyseal sleeve, due to severe bone loss in the distal femur. Postoperatively, the patient progressed well and returned to his activities of daily living, and, at about 3 months, had a pain-free left knee, without a disturbance of his prior limb-length discrepancy.

Conclusion

This is a rare case of a metaphyseal sleeve being used in a younger patient, revealing the potential for this procedure to be used in cases of primary total knee arthroplasty in patients with posttraumatic osteoarthritis.

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