Superior Survivorship for Posterior Stabilized Versus Constrained Condylar Articulations After Revision Total Knee Arthroplasty: A Retrospective, Comparative Analysis at Short-Term Follow-Up

Kunze, Kyle N.; Akram, Faisal; Fuller, Brian C.; Choi, Justin; Sporer, Scott M.; Levine, Brett R.

doi:10.1016/j.arth.2019.07.008

Cited by 8 publications

(12 citation statements)

References 12 publications

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“…Prosthesis choice in rTKA may be related to patient outcomes, with lower constrained implants appearing to confer a benefit when not contraindicated. Several studies have found increasing constraint to be an independent risk factor for inferior outcomes when compared to primary implants [5, 21]. The Australian National Joint registry [2] reported a 10 year revision rate of 6% for PS, 9.3% for fully stabilised and 12.7% for hinged level of constraint implants.…”

Section: Discussionmentioning

confidence: 99%

“…Hamilton et al [14] showed similar results when comparing patients undergoing aseptic rTKA with a CCK total stabilised (TS) implant to a cohort of cruciate‐retaining (CR) primary implants. Several other studies have compared rTKA PS implants with Condylar Constrained Knee (CCK) or Rotating Hinge Knee (RHK) implants [16, 21, 27]. Peters et al showed no differences in outcomes between PS and CCK rTKAs.…”

Section: Discussionmentioning

confidence: 99%

“…Prosthesis constraint in the revision implant may be a modifiable factor that also impacts on patient outcomes [25]. Higher rates of failure and aseptic loosening have been observed in constrained prosthesis, which has been attributed to increased implant‐bone load transmission [5, 21]. Consequently, several authors have recommended that the lowest level of constraint necessary to achieve a stable knee be used in rTKA [17, 25].…”

Section: Introductionmentioning

confidence: 99%

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Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months

Sappey‐Marinier

Fratini

Kremer

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of the study was to compare clinical and radiological outcomes between primary and aseptic revision TKAs using the same posterior-stabilised (PS) prosthesis. The authors hypothesised similar outcomes between both groups for selected patients. Methods This retrospective, case-control study assessed 36 patients who underwent aseptic revision TKA compared to a match group of 72 primary TKA. Both groups had the same PS design implant (ANATOMIC®, Amplitude, Valence, France). The International Knee Society (IKS) score, radiological outcomes (postoperative alignment, patellar tilt and radiolucent lines), re-intervention and revision rate were compared between the two groups with a minimum follow-up of 3 years. ResultsThe inal study cohort included 29 patients and 63 patients respectively in the revision and primary group, with a mean follow-up of 49.1 months (range 36.1-69). Postoperatively, there was no signiicant diference in IKS scores between the two groups [169.8 for the revision group and 179.6 for the primary group (p = 0.09)]. No statistical diference was observed for post-operative satisfaction 86.2% versus 92.1% (p = 0.46). Between the two groups, there was no diference in mean radiological assessment, including radiolucent lines (p = 0.7). There was no signiicant diference for overall implant survivorship 96.5% versus 100% (p = 0.13) at 36 months. Conclusion Similar clinical, radiological and survivorship outcomes were found between rTKA and primary TKA groups using the same PS level of constraint in patients undergoing revision surgery for aseptic indications at 3-year follow-up. Use of PS implants in rTKA for the correct indication suggests this to be a safe approach at least in the medium term. Level of evidence IV, retrospective case-control study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months

Sappey‐Marinier

Fratini

Kremer

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…27 Kunze et al found that compared with a constrained condylar insert, revision TKAs that used a PS insert had better knee flexion, Knee Society functional scores, and improved survivorship with a revision odds ratio of 0.3, p = 0.001. 28 Similarly, in a retrospective matched cohort analysis of 817 PS knee revisions and 817 constrained condylar knee (CCK) revisions, Moussa et al found that the PS inserts had significantly lower all-cause re-revision and re-revision for mechanical failure. 29 It is important to consider, however, that the findings of these comparative studies are inherently confounded by the fact that increased constraint is typically used in more complex revisions with collateral ligament damage and bone loss in which outcomes and survival are less predictable.…”

Section: Choosing Level Of Constraintmentioning

confidence: 99%

“…Multiple studies have demonstrated improved outcomes and survivorship with PS inserts in revision TKA compared with more constrained constructs. [27][28][29] A level IV retrospective analysis of 61 patients who underwent revision with standard PS inserts found that at 4-year minimum follow-up, 91% of patients had <5 degrees of coronal laxity, 90% had less than 5 mm AP laxity, and only two patients underwent rerevision (one for infection and one for periprosthetic fracture). 27 Kunze et al found that compared with a constrained condylar insert, revision TKAs that used a PS insert had better knee flexion, Knee Society functional scores, and improved survivorship with a revision odds ratio of 0.3, p ¼ 0.001.…”

Section: Ultracongruent/anterior Stabilizedmentioning

confidence: 99%

Ligament Balancing and Constraint in Revision Total Knee Arthroplasty

Crawford

Lombardi

2021

J Knee Surg

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Ligament balancing in revision knee arthroplasty is crucial to the success of the procedure. The medial collateral ligament and lateral ligament complex are the primary ligamentous structures that provide stability. Revisions can be performed with nonconstrained cruciate-retaining, posterior cruciate substituting, or anterior-stabilized/ultracongruent inserts when there are symmetrical flexion/extension gaps and intact collateral ligaments. When the collateral ligaments are insufficient either due to attenuation or incompetence from bone loss, a more constrained knee system is needed. Constrained condylar knees provide increased stability to both varus/valgus and rotation forces with a nonlinked construct. This increased constraint, however, does lead to increased stress at the implant–bone interface which requires more robust metaphyseal fixation. In cases of significant soft tissue disruption, severe flexion/extension gap mismatch or extensor mechanism disruption, a rotating hinge knee is needed to restore stability. Advances in revision implant design have led to improved outcomes and longer survivorship then earlier iterations of these implants. Surgeons should always strive to use the least constraint needed to achieve stability but must have a low threshold to increase constraint when ligament integrity is compromised.

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Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta‐analysis

Stroobant,

de Taeye,

Byttebier

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA. Methods Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component. Results A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°). Conclusion This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated. Level of evidence IV.

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Superior Survivorship for Posterior Stabilized Versus Constrained Condylar Articulations After Revision Total Knee Arthroplasty: A Retrospective, Comparative Analysis at Short-Term Follow-Up

Cited by 8 publications

References 12 publications

Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months

Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months

Ligament Balancing and Constraint in Revision Total Knee Arthroplasty

Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta‐analysis

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