Revision Total Knee Arthroplasty Using the Modern Constrained Condylar Knee Prosthesis

Nakano, Nobuaki; Matsumoto, Tomoyuki; Muratsu, Hirotsugu; Ishida, Kazunari; Kuroda, Ryosuke; Kurosaka, Masahiro

doi:10.1590/1413-785220162406146213

Cited by 7 publications

(5 citation statements)

References 19 publications

(28 reference statements)

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“…Revision total knee arthroplasty (RTKA) associated with bone loss and ligament instability is often more challenging than primary total knee arthroplasty with higher complication rates. [ 1 ] Thus, selecting the proper prosthesis when referring to the preoperative state of the joint is important for successful outcomes; varying levels of constraint are required in RTKA especially when dealing with bone loss and collateral insufficiency. The two commonly used prostheses of RTKA are rotating hinge knee (RHK) and constrained condylar knee (CCK).…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 – 4 ] The midterm results have reported on improved survivorship compared to older design without axial rotation. [ 1 ] In spite of these improvements, recurrent infection and aseptic loosening are still issues for RHK in RTKA. Therefore, CCK type implants have increased in popularity as an alternative to RHK because it can require less bone resection, has good midterm survivorship, and allows for future salvage type procedures such as RHK if necessary.…”

Section: Introductionmentioning

confidence: 99%

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Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: A meta-analysis

Yoon

Cheong

et al. 2019

PLoS ONE

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There is debate in the literature whether rotating hinge knee (RHK) or constrained condylar knee (CCK) prostheses lead to better clinical outcomes and survival rates in patients undergoing revision total knee arthroplasty (RTKA). The purpose of this meta-analysis is to compare the survivorship and clinical outcomes of RHK and CCK prostheses. In this meta-analysis, we reviewed studies that evaluated pain and function scores, range of motion (ROM), complications, and survival rates in patients treated with RHK or CCK with short-term (<5 years) or midterm (5–10 years) follow-up. The survivorship was considered as the time to additional surgical intervention such as removal or revision of the components. A total of 12 studies (one randomized study and 11 non-randomized studies) met the inclusion criteria and were analyzed in detail. The proportion of the knees in which short-term (<5 years) survival rates (RHK, 83/95; CCK, 111/148; odds ratio [OR] 0.52; 95% CI, 0.24–1.11; P = 0.09) and midterm (5–10 years) survival rates (RHK, 104/128; CCK, 196/234; OR 1.05; 95% CI, 0.56–1.97; P = 0.88) were evaluated did not differ significantly between RHK and CCK prostheses. In addition, there were no significant differences in ROM (95% CI: -0.40 to 9.93; P = 0.07) and complication rates (95% CI: 0.66 to 2.49; P = 0.46). In contrast, CCK groups reported significantly better pain score (95% CI: 0.50 to 2.73; P = 0.005) and function score (95% CI: 0.01 to 2.00; P = 0.05) than RHK groups. This meta-analysis revealed that 87.4% of RHK and 75.0% of CCK prostheses survive at short-term (<5 years), while 81.3% of RHK and 83.8% of CCK prostheses survive at midterm (5–10 years). The differences in standardized mean pain and function scores we detected were likely to be imperceptible to patients and almost certainly below the minimum clinically important level, despite a significant difference in both groups. Based on the findings of the current meta-analysis, RHK prostheses continue to be an option in complex RTKA with reasonable midterm survivorship.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: A meta-analysis

Yoon

Cheong

et al. 2019

PLoS ONE

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“…1,10,11 The diminished clinical results of revision TKA have been attributed to multiple factors, including ligamentous instability, soft tissue incompetence, and extensor mechanism problems. 12 Functional outcomes have been shown to vary based on the mode of failure of the primary arthroplasty with revisions for infection shown to have the worst out-comes. 1,4,13,14 For this reason, we did not include revisions for infection in our study in an attempt to minimize variables.…”

Section: Discussionmentioning

confidence: 99%

Can Revision TKA Patients Achieve Similar Clinical Functional Improvement Compared to Primaries?

et al. 2019

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The etiology of failure following primary total knee arthroplasty (TKA) leading to revision surgery are multifactorial, including infection, instability, loosening, contracture, and wear. Although the majority of patients have successful outcomes following revision TKA, postoperative complications are still increased in these patients when compared to primary patients. For this reason, there has been a continued search to identify options, including prosthesis types, to potentially improve outcomes. Therefore, the purpose of this study was to determine if the clinical results achieved following revision TKA are comparatively similar to primaries using the same implant design. Specifically, we compared (1) Knee Society Functional and Range-of-Motion Knee Scores and (2) component survivorship. This was a retrospective analysis of 100 patients undergoing revision TKA due to an aseptic etiology, who were matched to a cohort of 100 patients who underwent primaries with the same prosthesis. There were no differences in the groups with respect to age at surgery, sex, and body mass index. The mean follow-up was 57 months in the revision group (range 24–105 months) and 67 months in the primary TKA group (range 55–123 months). American Knee Society Scores (KSS) and range of motion measurements recorded preoperatively and at the most recent postoperative visit were compared between both cohorts in order to compare postoperative outcomes. A p value of 0.05 was used for significance. The average improvement between the pre- and postoperative KSS function scores in both groups was similar, with both cohorts demonstrating a 28-point improvement. At 2-year follow-up, all-cause survivorship of the aseptic revision surgeries was 87%. Patients undergoing revision TKA for aseptic loosening can potentially expect similar improvements in clinical function scores and survivorship compared to primary TKA when controlling for implant type.

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“…An insert of a constrained condylar knee prosthesis is characterised by the high and broad central post that fits closely against the femoral cam, providing increased stability 10. A constrained hinged design is indicated in case of global ligamentous deficiency, but is associated with suboptimal outcomes 11.…”

Section: Discussionmentioning

confidence: 99%

Knee joint instability after total knee replacement in a patient with Ehlers-Danlos syndrome: the role of insert changes as practical solution

et al. 2018

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Treatment of knee joint instability in patients with hypermobile Ehlers-Danlos syndrome (EDS) can be challenging. A 53-year-old woman with hypermobile EDS underwent bilateral total knee replacement (TKR) due to valgus osteoarthritis. During follow-up, she developed hypermobility of both knee replacements. Revision of the insert resolved the issue in her left knee; however, the right TKR required two insert exchanges and unfortunately instability persisted. Therefore, a revision to a constrained prosthesis was performed. Insert exchanges in an unstable TKR can give short-term benefits, but for the long-term, we would recommend a constrained prosthesis.

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Revision Total Knee Arthroplasty Using the Modern Constrained Condylar Knee Prosthesis

Cited by 7 publications

References 19 publications

Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: A meta-analysis

Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: A meta-analysis

Can Revision TKA Patients Achieve Similar Clinical Functional Improvement Compared to Primaries?

Knee joint instability after total knee replacement in a patient with Ehlers-Danlos syndrome: the role of insert changes as practical solution

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