Difficult primary total knee arthroplasty requiring a varus–valgus constrained implant is at higher risk of periprosthetic infection

Abstract

Purpose The goal of this study was to compare the risk of periprosthetic infection of a consecutive cohort of primary varusvalgus constrained (VVC) total knee arthroplasties (TKAs), with a matched 1:1 cohort of primary posterior-stabilized (PS) TKAs. Methods 74 primary VVC TKAs performed in 66 patients were identiied and matched 1:1 with a cohort of 74 primary PS TKAs performed in 73 patients. At last follow up, patients were clinically evaluated using the Knee Society Score (KSS). Kaplan-Meier survival curves were generated to analyze survivorship using as endpoints revision for any reason, revision for periprosthetic infection and revision for mechanical failure after excluding periprosthetic infection. A multivariate logistic regression analysis was constructed to determine whether revision surgery for periprosthetic infection was inluenced by patients' gender, age, surgical time and reasons for TKA (primary vs secondary osteoarthritis). Results Demographic data were not signiicantly diferent between the two groups as regard patients' age, gender, body mass index, Charlson Comorbidity Index, reasons for replacement, and length of follow-up. Surgical time was greater in the VVC group (95.7 ± 22.5 min vs 88.6 ± 17.1 min, respectively, p = 0.032). Postoperative KSS, range of motion and radiographic data did not difer signiicantly between the two groups. Overall revision rate and revision rate for mechanical failure after 5 years of follow-up was not statistically diferent between the two groups. Considering only the revision rate due to periprosthetic infection, the risk was higher in patients with primary VVC implants (p = 0.013). The surgical time was the only factor that signiicantly afected the risk of revision for periprosthetic infection (OR 1.0636, CI 95% 1.0209-1.1081, p = 0.0032), whereas patients' gender, age and reason for TKA had no inluence. Conclusions Patients and surgeons should be aware of the higher risk of periprosthetic knee infection using a VVC prosthesis. However, the present study supports the use of VVC implants in cases of diicult knee replacements, since comparable clinical outcomes and overall revision rate was found after at least 5 years of follow up. Level of evidence Retrospective cohort study, Level III.

A Comparison Between Unstemmed and Stemmed Constrained Condylar Knee Prostheses in Primary Total Knee Arthroplasty: A Propensity Score‐Matched Analysis

“…Therefore, this demonstrated that CCK without stem extension did not have a markedly negative effect on implant survivorship among patients with adequate bone quality. Furthermore, Costa et al 28 reported that stemmed CCK implants were at a higher revision rate due to periprosthetic infection, which was further confirmed by the present study.…”

Midterm Survival of a Varus–Valgus Constrained Implant following One-Stage Revision for Periprosthetic Joint Infection: A Single-Center Study

“…The VVC prosthesis system was designed to have more constraints than the PS but fewer constraints than the hinge implant. Compared with the number of studies on the outcomes and survival of VVC prostheses in complex primary TKA and aseptic revision, 20,21 there is a paucity of studies reporting the survival of VVC implants following revision for infection. To our knowledge, only one study reported the outcomes of two-stage revision, 22 and no studies reported the outcomes of one-stage revision.…”

“…The survival rates of the prostheses in this study were better than those in earlier reports and were comparable to those in recent reports. The failure rate for the VVC prosthesis used in the primary TKAs ranged from 0 to 22%, 20,26,27 and the rate ranged from 0 to 35.7% for revisions. 22,27,28 In the only study that has reported the outcomes of two-stage revision using the VVC implant, Wilke et al 22 reported a case with 71% overall 5-year survival and an estimated 64% 10-year survival when repeat revision surgery was used as the end point.…”

What You Should Know About Osteoarthritis Rehabilitation: A Bibliometric Analysis of the 50 Most-Cited Articles

“…2 Although surgical treatment, such as arthroplasty, is an effective method for the treatment of osteoarthritis, the risks of surgery and the acceptance of patients need to be considered by clinical staff. 3,4 The management of osteoarthritis should be based on individualized approaches. 5 Clinicians should identify and manage the risk factors that lead to patients' conditions, which can effectively improve their joint metabolism and biomechanical state to relieve joint pain and delay surgical interventions.…”