Isolated Polyethylene Insert Exchange for Flexion Instability After Primary Total Knee Arthroplasty Demonstrated Excellent Results in Properly Selected Patients

The Role of Constraint in Revision Total Knee Replacement for Instability: Full Component Revision Vs Isolated Polyethylene Exchange in Selected Patients

“…The similarity in outcomes we observed between our component revision and IPE cohorts is consistent with previous studies [ [8] , [9] , [10] , [11] ]. Despite this, the identification of the specific parameters, which make IPE the best choice for a given patient have been elusive.…”

“…Some recent studies have suggested that IPE leads to inferior outcomes when performed for instability [ [13] , [14] , [15] ], and yet in every series, there were some patients that fared well with this treatment protocol [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , 16 ]. It is that population that we seek to understand.…”

“…The gold standard for treatment of TKA instability is a one or both component revision with optimization of alignment of components and equalization of flexion and extension gaps, but this type of revision surgery is complex and recovery can be prolonged [ 5 , 7 ]. Previous studies have reported that isolated polyethylene exchange (IPE), an alternative with lower associated morbidity, can be as successful as component revision in select patients with rerevision rates as low as 6.3% when constraint is increased [ [8] , [9] , [10] , [11] , [12] ]. However, the use of IPE to treat TKA instability remains controversial with some groups reporting rerevision rates as high as 60% [ [13] , [14] , [15] ].…”

Ligament Balancing and Constraint in Revision Total Knee Arthroplasty

“…At a mean 41-month follow-up, the authors found a significant improvement in Knee Society pain and function scores along with a survivorship of 89.5% in the CR to UC group. 26…”

“…At a mean 41-month follow-up, the authors found a significant improvement in Knee Society pain and function scores along with a survivorship of 89.5% in the CR to UC group. 26 Posterior-Stabilized Insert PS inserts are used in about half of the primary TKAs in the United States (American Joint Replacement Registry). In the revision setting, PS inserts can be used with the primary components when doing an isolated polyethylene exchange or be used with revision components.…”