Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis

Abstract

BackgroundKey to a successful outcome of total knee arthroplasty (TKA) is to attain optimum alignment, adequate balance, and deformity correction. In primary TKA, this can be achieved efficiently by posterior stabilized (PS) design with or without the sub-periosteal release. However, certain circumstances such as post-traumatic arthritis are often associated with severe deformities with a significant bone defect, stiffness, and instability. Such deformities are extremely difficult to balance with soft tissue release only and require additionally constrained prostheses even in primary TKA. In such situation, constrained condylar knee (CCK) design is the ultimate choice. This study primarily aimed to report on clinical outcome, regain of function, and complication of patients who underwent primary CCK-TKA for severe deformity of the knee secondary to post-traumatic arthritis. The secondary aim was to find out the mid-term prostheses survival.MethodsBetween February 2007 and November 2013, 38 consecutive patients with post-traumatic arthritis of the knee received cemented primary CCK-TKA. Thirty-four patients (21 men and 13 women) who had a minimum of 3 years follow-up were included in this retrospective study. We used Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, and roentgenographic evaluation form to assess the patients. Prostheses survival was assessed using Kaplan-Meier’s survival analysis.ResultsPatients were followed up for an average duration of 6.47 years. KSS knee score improved from 44 points (23–68) pre-operatively to 91 points (76–100) post-operatively [P < 0.001]. The average KSS functional score improved from 49 points (20–75) pre-operatively to 91 points (65–100) post-operatively [P < 0.001]. The average HSS score improved from 51 points (27–83) pre-operatively to 91 points (75–100) post-operatively [P < 0.001]. Similarly, the average ROM improved from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) post-operatively [P < 0.001]. The average hip-knee-ankle (HKA) angle was 176.88° ± 14.48° (135°–199°) pre-operatively and 180.24° ± 1.77° (175°–184°) post-operatively. Radiolucencies were evident in 13 knees, mostly on the tibial side. Prostheses survival was 94.7% at a mean follow-up of 6.47 years.ConclusionDespite severe deformity, instability, and stiffness at a relatively young age, mid-term follow-up of primary CCK-TKA in post-traumatic arthritis provides satisfactory clinical and functional outcomes with 94.7% prostheses survival. However, it is not without complication.

Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994–2017

“…Rai et al. (2018) found similar implant survival (95%) to our study and with a high complication rate for CCK. CCK used by Sabatini et al.…”

“…(2017) and Rai et al. (2018)found a high number of patients with intraoperative complications such as fractures and ligament injuries.…”

Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique

“…Historically, concerns for using constrained implants in TKA are related to the increased stress at the bone-cement-implant interface as well as the sacrifice of more bone, which have been associated with higher risk for aseptic loosening and revision [ [13] , [14] , [15] ]. However, several studies have still demonstrated favorable outcomes for constrained TKA implants at the index surgery, if indicated [ [16] , [17] , [18] ]. Nonconstrained implants should be considered in Blount disease with less severe deformities; however, it should be noted that in the report by Natoli et al., 2 of the 6 knees in that series that underwent the surgery without constrained components were subsequently revised to hinge components [ 6 ].…”

The role of an Orthopaedic Surgeon in the time of Covid-19 Pandemic–a German perspective

“…Naturally, the consequence of that behaviour will be a higher number of patients coming in at later stage with more pronounced bony defects and deformities and due to that more difficult to treat. This can also have an impact on the outcome and on the complication rate 5,6 . Keeping in contact with patients (i.e.with the help of digital platforms, such as video consultation) is one option to help them through this time but also to give them a time line for their postponed surgery.…”