Midlevel Constraint Without Stem Extensions in Primary Total Knee Arthroplasty Provides Stability Without Compromising Fixation

Crawford, David A.; Law, Jesua I.; Lombardi, Adolph V.; Berend, Keith R.

doi:10.1016/j.arth.2018.03.070

Cited by 18 publications

(21 citation statements)

References 26 publications

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“…The authors reported one revision for aseptic tibial component loosening in the VVC insert group (0.4%) and no cases of aseptic loosening in the PS group at a mean follow-up of 3.25 years. 10 Similarly, Crawford et al, 7 in a series of 96 patients (103 TKAs), reported no cases of aseptic loosening at a mean follow-up of five years with mid-level constraint without stems in primary TKA. Anderson et al, 14 in a series of 248 non-modular constrained condylar primary TKAs without stem extensions, reported one case of aseptic loosening, which required a femoral component revision and the addition of a diaphyseal stem.…”

Section: Discussionmentioning

confidence: 95%

“…Similar results are reported in various other studies that used constrained implants in complex primary TKAs. 5 , 7 , 8 , 13 One comparable study examined the outcomes of PS femoral implants with two different inserts, a PS insert (n = 244) and a VVC insert (n = 242), all without stemmed components. The authors reported one revision for aseptic tibial component loosening in the VVC insert group (0.4%) and no cases of aseptic loosening in the PS group at a mean follow-up of 3.25 years.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] However, VVC devices have become more commonly used in complex primary TKAs, often without the use of adjunctive stem fixation. [5][6][7][8] In at least one system, the VVC insert is compatible with the primary posterior-stabilized (PS) femoral component. 9 Surgeons may be tempted to occasionally pair that VVC insert with a standard, non-stemmed PS femur in unique, complex primary situations (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…With such unconventional use, loosening of components is a concern. 7 There is a paucity of literature on the use of a PS femoral component without stems with a VVC insert in the setting of primary TKA. 10 The aims of this study were to determine the implant survivorship, radiological and clinical outcomes, and complications when this VVC insert was coupled with a PS femur without stems in complex primary TKAs.…”

Section: Introductionmentioning

confidence: 99%

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Varus-valgus constrained insert with posterior-stabilized femoral components in complex primary total knee arthroplasties

et al. 2021

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Aims Varus-valgus constrained (VVC) devices are typically used in revision settings, often with stems to mitigate the risk of aseptic loosening. However, in at least one system, the VVC insert is compatible with the primary posterior-stabilized (PS) femoral component, which may be an option in complex primary situations. We sought to determine the implant survivorship, radiological and clinical outcomes, and complications when this VVC insert was coupled with a PS femur without stems in complex primary total knee arthroplasties (TKAs). Methods Through our institution’s total joint registry, we identified 113 primary TKAs (103 patients) performed between 2007 and 2017 in which a VVC insert was coupled with a standard cemented PS femur without stems. Mean age was 68 years (SD 10), mean BMI was 32 kg/m2 (SD 7), and 59 patients (50%) were male. Mean follow-up was four years (2 to 10). Results The five-year survivorship free from aseptic loosening was 100%. The five-year survivorship free from any revision was 99%, with the only revision performed for infection. The five-year survivorship free from reoperation was 93%. The most common reoperation was treatment for infection (n = 4; 4%), followed by manipulation under anaesthesia (MUA; n = 2; 2%). Survivorship free from any complication at five years was 90%, with superficial wound infection as the most frequent (n = 4; 4%). At most recent follow-up, two TKAs had non-progressive radiolucent lines about both the tibial and femoral components. Knee Society Scores improved from 53 preoperatively to 88 at latest follow-up (p < 0.001). Conclusion For complex primary TKA in occasional situations, coupling a VVC insert with a standard PS femur without stems proved reliable and durable at five years. Longer-term follow-up is required before recommending this technique more broadly. Cite this article: Bone Jt Open 2021;2(11):921–925.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Varus-valgus constrained insert with posterior-stabilized femoral components in complex primary total knee arthroplasties

et al. 2021

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“…It is characterized by a wider post that limits rotation and varus-valgus lift-off to a few degrees but is less constrained than a CCK insert. Crawford et al [39], in a cohort of 103 stemless MLC articular-bearing implants, reported overall survivorship of 97% and survivorship from revision for aseptic loosening or instability of 100% at a mean follow-up of 5 years. Those findings are supported by Dubin et al [40] in their series of 57 MLC knees compared with 96 PS knees with a mean follow-up of 4 years.…”

Section: Discussionmentioning

confidence: 99%

Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up

et al. 2020

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Background The purpose of this study was to evaluate (1) the reoperation rates and survivorship for septic and aseptic causes, (2) radiographic outcomes, and (3) clinical outcomes of condylar-constrained knee (CCK) implants used in primary total knee arthroplasty (TKA) with severe coronal deformity and/or intraoperative instability. Materials and methods A consecutive series of CCK implants in primary TKA was retrospectively evaluated in patients with severe coronal deformities. Forty-nine patients (54 knees) were included with a mean follow-up of 9 years (range 6–12). All patients were treated with a single-design, second-generation CCK implant. The primary diagnosis was osteoarthritis in 36 knees, post-traumatic arthritis in 7 knees, and rheumatoid arthritis in 4 knees. Preoperatively, standing femorotibial alignment was varus in 22 knees and valgus in 20 knees. Results At a mean follow-up of 9 years, overall survivorship was 93.6%. Two knees (4.3%) required revision for periprosthetic joint infection. One knee (2.1%) required subsequent arthroscopy due to patellar clunk syndrome. At final follow-up, no evidence of loosening or migration of any implant was reported, and the mean Knee Society knee scores improved from 43 to 86 points (p < 0.001). The mean Knee Society function scores improved to 59 points (p < 0.001). The average flexion contracture improved from 7° preoperatively to 2° postoperatively and the average flexion from 98° to 110°. No knees reported varus–valgus instability in flexion or extension. Conclusion CCK implants in primary TKA with major coronal deformities and/or intraoperative instability provide good midterm survivorship, comparable with less constrained implants. In specific cases, CCK implants can be considered a viable option with good clinical and radiographic outcomes. However, a higher degree of constraint should be used cautiously, leaving the first choice to less constrained implants. Level of evidence Therapeutic study, level IV.

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Severe Instability

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2024

Advances in Total Knee Arthroplasty

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Midlevel Constraint Without Stem Extensions in Primary Total Knee Arthroplasty Provides Stability Without Compromising Fixation

Cited by 18 publications

References 26 publications

Varus-valgus constrained insert with posterior-stabilized femoral components in complex primary total knee arthroplasties

Varus-valgus constrained insert with posterior-stabilized femoral components in complex primary total knee arthroplasties

Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up

Severe Instability

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