Key Takeaways & Executive Findings
- •• Sleeve+ extension rod combined with MBT prosthesis effectively corrects joint alignment, fills bone defects, and improves pain and knee function in non-infectious knee revision. • Artificial intelligence preoperative planning achieved high matching rates for femoral and tibial components (85% and 62%), enhancing surgical accuracy and reducing complexity. • Significant improvements in VAS pain scores, knee range of motion, hip-knee-ankle angle, and KSS scores were observed at final follow-up (P < 0.01). • The procedure demonstrated favorable early and mid-term outcomes with minimal complications, supporting its use in complex revision cases.
Abstract
BACKGROUND: With the widespread application of total knee arthroplasty in China, non-infectious prosthesis loosening has become one of the main reasons for postoperative revision. For complex loosening cases, traditional revision techniques are relatively complex and difficult. The application of artificial intelligence-assisted preoperative planning combined with Sleeve extension rods and mobile bearing tray prostheses provides a new solution for precisely reconstructing joint stability and mechanical alignment, which is expected to improve the long-term outcomes of revision surgeries. OBJECTIVE: To explore the mid-and early-term clinical efficacy of revision surgery for non-infectious total knee prosthesis loosening using Sleeve extension rods combined with mobile bearing tray prostheses under the assistance of artificial intelligence-assisted preoperative planning. METHODS: A retrospective analysis was conducted on 17 patients with non-infectious prosthesis loosening after total knee arthroplasty in Department of Orthopedics and Traumatology, Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2021 to September 2024. There were 6 males and 11 females, aged 59-81 years (mean 72.06±6.10 years). The affected side was left in 8 cases and right in 9 cases. The duration of prosthesis use ranged from 2 to 22 years (mean 10.53±4.60 years). All cases were revisions after primary arthroplasty. Revision reasons included periprosthetic osteolysis with liner wear in 15 cases, femoral condyle old fracture causing loosening in 1 case, and tibial plateau prosthesis fracture in 1 case. According to AORI classification, there were 13 cases of type IIB and 4 cases of type IIA. The artificial intelligence-designed prosthesis sizes were recorded and compared with the actual intraoperative sizes. Visual analog scale (VAS) score, American Knee Society knee score, hip-knee-ankle angle, and knee range of motion were compared preoperatively, at 1 week, 6 months, and 12 months postoperatively to evaluate surgical efficacy. RESULTS AND CONCLUSION: (1) Except for one patient with poor incision healing at 1 month postoperatively, all other patients recovered well without adverse events such as deep vein thrombosis, infection, periprosthetic fracture, or prosthesis loosening. (2) The follow-up period ranged from 6 to 41 months (mean 23.63±12.50 months). At the last follow-up, 2 patients had slight soreness and discomfort after activity, and 1 patient had obvious pain during activity. (3) At the last follow-up after revision, resting pain, exercise pain VAS scores, affected side range of motion, hip-knee-ankle angle, and American Knee Society knee score were significantly improved compared with preoperative values (P < 0.01). (4) The matching rate of artificial intelligence preoperative design for femoral condyle and tibial plateau prostheses was 85%, and the matching rate for other components was 62%. (5) The use of Sleeve+ extension rod combined with MBT prosthesis for non-infectious knee revision can effectively correct joint alignment, fill bone defects, improve pain and knee range of motion, and enhance patients' quality of life, with good early and mid-term efficacy. Artificial intelligence preoperative planning generally helps improve surgical accuracy, reduce revision difficulty, minimize risks, and promote postoperative recovery.
1. Introduction
In recent years, the number of total knee arthroplasty procedures in China has been increasing. With the prolonged service life of primary prostheses, the number of patients requiring revision due to various factors has also gradually increased [1-2], such as infection, prosthesis loosening, bone defects, and knee stiffness [3-4]. Among these, periprosthetic joint infection is the most common [5], followed by prosthesis loosening [6-7]. Prosthesis loosening is a major cause of knee instability, pain, and limited mobility, and is one of the main indications for knee revision surgery [8-9]. Restoring knee stability, reconstructing soft tissue balance, and filling periprosthetic bone defects are key to successful revision surgery [10]. Currently, the use of femoral and tibial extension rods is popular to correct limb alignment, reduce shear forces at the femoral and tibial interfaces, and enhance joint stability [11]. Sleeve sleeves combined with metal blocks can effectively address bone defects in the metaphysis, femoral condyle, and tibial plateau. In addition, mobile bearing tray (MBT) prostheses can better match femoral and tibial components, improving long-term implant survival, and patients may experience better proprioception and functional recovery postoperatively [12-13].
Knee revision surgery still faces many challenges, including prosthesis loosening, infection, and wear. Therefore, selecting appropriate prostheses and surgical techniques is crucial to ensure successful outcomes. This study aims to evaluate the early and mid-term clinical efficacy of artificial intelligence-assisted preoperative planning combined with Sleeve extension rods and MBT prostheses in revision surgery for non-infectious total knee prosthesis loosening.
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CAO Xun, ZHENG Shanbin, SUN Jiahao, CHEN Zhiyuan, ZHU Jiaqing, MA Bowen, XIA Tianwei, ZHANG Chao, SHEN Jirong (2026). Preoperative Planning Assisted Sleeve+ Extension Rod Combined with MBT Prosthesis in Revision for Non-infectious Knee Prosthesis Loosening. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21395
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Frequently Asked Questions
What is the main cause of non-infectious knee prosthesis loosening?
Non-infectious knee prosthesis loosening is primarily caused by long-term wear of the prosthesis, leading to metal debris that triggers an immune response, resulting in osteolysis and bone defects, which in turn cause prosthesis displacement, subsidence, or angulation.
How does artificial intelligence preoperative planning improve knee revision surgery?
Artificial intelligence preoperative planning allows for three-dimensional reconstruction of the patient's knee from CT and X-ray images, enabling precise assessment of bone defects and accurate selection of prosthesis sizes, thereby improving surgical accuracy, reducing complexity, and minimizing risks.
What are the advantages of using Sleeve extension rods combined with MBT prostheses in revision surgery?
Sleeve extension rods help correct limb alignment and fill bone defects, while MBT prostheses provide better stability and stress distribution, reducing wear and loosening risk, and promoting more natural knee function.
What were the clinical outcomes of the study?
The study showed significant improvements in pain scores, knee range of motion, hip-knee-ankle angle, and knee society scores at final follow-up, with a low complication rate, indicating favorable early and mid-term outcomes.
What is the matching rate of AI-designed prosthesis sizes in this study?
The matching rate for femoral condyle and tibial plateau prostheses was 85%, while the matching rate for other components was 62%, demonstrating the utility of AI planning in enhancing surgical precision.
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