Total knee arthroplasty in valgus knees: Predictive preoperative parameters influencing a constrained design selection

Girard, Julien; Amzallag, M.; Pasquier, Gilles; Mulliez, A.; Brosset, T.; Gougeon, F.; Duhamel, A.; Migaud, Henri

doi:10.1016/j.otsr.2009.04.005

Cited by 53 publications

(25 citation statements)

References 32 publications

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“…No mention was made about the influence of bone loss on the use of a CCK prosthesis. Moreover, most of the recent studies on CCK results have been performed in (difficult) primary knee replacements [16][17][18], whereas bone loss is rarely encountered.…”

Section: Discussionmentioning

confidence: 99%

“…Condylar constrained knee (CCK) prostheses are semi-constrained nonhinged implants, which represent an excellent alternative to the hinged prostheses. CCK systems have been introduced more recently, being more suitable in cases of intermediate severity with insufficiency (but not absence) of the ligaments and moderate bone loss [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Constraint choice in revision knee arthroplasty

Vasso

Beaufils

Panni

2013

International Orthopaedics (SICOT)

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Purpose Along with the increase in primary total knee arthroplasty, there has been an increase in the number of revisions. The aim of this study was to propose a selection algorithm for the knee revision constraint according to the state of ligaments and to the bone defects Anderson Orthopaedic Research Institute Classification [AORI] classification. The hypothesis was that this algorithm would facilitate the appropriate choice of prosthesis constraint, thus providing stable components and a good long-term survivorship of the knee revisions. Methods Sixty consecutive revision knee arthroplasties in 57 patients were prospectively evaluated. Prostheses implanted at revision included postero-stabilised, condylar constrained and rotating hinged, relative to the state of the ligaments and of the bone loss around the knee. The median follow-up was nine years (range, 4-12). Results The median IKS knee and function scores and HSS score were 41 (15-62), 21.5 (12-43) and 34 (23-65) points, respectively, before the operation, and 81 (48-97), 79 (56-92) and 83.5 (62-98) points (p<0.001) at the latest followup evaluation. The median ROM increased from 74°(29-110°) preoperatively to 121°(98-132°) (p<0.01) at the final follow-up. Re-revision was necessary in five (8.3 %) patients. Conclusions A selection algorithm for the revision implant constraint based on the state of ligaments and the bone loss AORI classification could provide stable knee reconstructions and long-term success of knee revisions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Constraint choice in revision knee arthroplasty

Vasso

Beaufils

Panni

2013

International Orthopaedics (SICOT)

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“…Sigma TC3; DePuy Synthes Joint Reconstruction, Leeds, UK) [7], an RH implant should be used instead of a CC implant when the medial collateral ligament (MCL) is absent. Many papers support the use of CC over PS-TKA when the MCL is present and lax, and the use of a RH over CC-TKA with absence of the MCL [10, 11, 23, 32]. This is not always followed clinically as surgeons would prefer to minimise size and constraint of the implant and still achieve stability.…”

Section: Introductionmentioning

confidence: 99%

An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty

Athwal

Daou

Inderhaug

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of this study was to quantify the medial soft tissue contributions to stability following constrained condylar (CC) total knee arthroplasty (TKA) and determine whether a medial reconstruction could restore stability to a soft tissue-deficient, CC-TKA knee.MethodsEight cadaveric knees were mounted in a robotic system and tested at 0°, 30°, 60°, and 90° of flexion with ±50 N anterior–posterior force, ±8 Nm varus–valgus, and ±5 Nm internal–external torque. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were transected and their relative contributions to stabilising the applied loads were quantified. After complete medial soft tissue transection, a reconstruction using a semitendinosus tendon graft was performed, and the effect on kinematic behaviour under equivocal conditions was measured.ResultsIn the CC-TKA knee, the sMCL was the major medial restraint in anterior drawer, internal–external, and valgus rotation. No significant differences were found between the rotational laxities of the reconstructed knee to the pre-deficient state for the arc of motion examined. The relative contribution of the reconstruction was higher in valgus rotation at 60° than the sMCL; otherwise, the contribution of the reconstruction was similar to that of the sMCL.ConclusionThere is contention whether a CC-TKA can function with medial deficiency or more constraint is required. This work has shown that a CC-TKA may not provide enough stability with an absent sMCL. However, in such cases, combining the CC-TKA with a medial soft tissue reconstruction may be considered as an alternative to a hinged implant.

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“…Constrained condylar TKA (CCK) system is recommended for patients having an unstable knee with severe deformity, medial collateral ligament (MCL) deficiency, and inadequate soft tissue balance during flexion and extension. Although constrained condylar implants provide reliable clinical outcomes (12) (13), these implants use modular stem extensions for both tibial and femoral components, which sometimes cause technical difficulties, increase the risk of large bone stockdeficiencies, and affect the implant longevity (14) (15).…”

Section: Introductionmentioning

confidence: 99%

Semi-constrained posterior stabilized total knee arthroplasty reproduces natural deep knee bending kinematics

Sumino

Tomita

Sugamoto

et al. 2019

Preprint

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Background The Flexible Nichidai Knee Posterior Stabilized (FNK-PS) system was designed to provide relatively high varus-valgus stabilities without the stem extensions to patients with severe knee joint disorders. This is a combination of a large tibial post and high femoral cam adapted to a PS system. The aim of our study was to analyze the in vivo two-dimensional/three-dimensional registration kinematics of the FNK PS-total knee arthroplasty (TKA) system during deep knee bending.Methods Nineteen knees from 15 total knee arthroplasty (TKA) patients who were able to squat with enough knee flexion were selected. During deep knee bending under weight bearing (WB) and non-weight bearing (NWB) conditions, we quantified range of motion, axial rotation, femoral anteroposterior translation, and post-cam engagement angle.Results The maximum-flexion was significantly different between the two conditions. The mean axial femoral external rotation was 4.8° and 6.2° under WB and NWB conditions, respectively, at 120° flexion. Anteroposterior translation based on bicondylar posterior roll-back patterns was noted with increasing knee flexion. Both the medial and lateral femoral aspects were significantly more posterior during early to mid-flexion. Initial post-cam engagement occurred significantly earlier during flexion under NWB than under WB conditions. Under WB, the timing of the post-cam engagement correlated with the maximum flexion.Conclusions The kinematics of the semi-constrained PS system reproducibly exhibited a mild external rotation with smooth posterior roll-back, comparable to that of standard PS-TKAs. This was assisted by the engagement of the large tibial post and high femoral cam during the early phase of flexion.

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Total knee arthroplasty in valgus knees: Predictive preoperative parameters influencing a constrained design selection

Abstract: Therapeutic retrospective study.

Cited by 53 publications

References 32 publications

Constraint choice in revision knee arthroplasty

Constraint choice in revision knee arthroplasty

An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty

Semi-constrained posterior stabilized total knee arthroplasty reproduces natural deep knee bending kinematics

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