Clinical and Functional Outcomes: Primary Constrained Condylar Knee Arthroplasty Compared With Posterior Stabilized Knee Arthroplasty

Puah, Ken Lee; Chong, Hwei Chi; Foo, Leon Siang Shen; Lo, Ngai-Nung; Yeo, Seng-Jin

doi:10.5435/jaaosglobal-d-17-00084

Cited by 17 publications

(18 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the disadvantages that have been associated with increased constraint, midterm survivorship from revision for aseptic loosening was 100%, which is in line with previous studies of primary CCK that reported no cases of failure of the implants for aseptic loosening at midterm follow-up in primary TKA [13,14,17,19,23,31,33]. Our results compare favorably with those of other studies [11,15,22,[34][35][36][37] (Table 3). No complications related to the tibial post mechanism were reported at a mean follow-up of 9 years (range 6-12 years).…”

Section: Discussionsupporting

confidence: 90%

“…Flexion contracture decreased from mean 7° in the preoperative evaluation to mean 2° at final follow-up. Puah et al [15] recently reported no significant difference in ROM or functional scores between primary CCK implants and PS implants at 6 months and 2 years.…”

Section: Discussionmentioning

confidence: 95%

“…Theoretical disadvantages have been addressed to an increased level of constraint including greater risk of loosening caused by the transmission of the mechanical stress to the bone-cement interface and subsequent increased polyethylene insert wear, particularly of the tibial post, leading to a higher prevalence of osteolysis [11,12,[14][15][16][17]. However, multiple studies have reported good short-to-midterm results of CCK implants in primary TKAs.…”

Section: Introductionmentioning

confidence: 99%

“…However, multiple studies have reported good short-to-midterm results of CCK implants in primary TKAs. In addition, range-of-motion (ROM) [17], clinical and radiographic outcomes seem to be comparable to standard PS implants in severe coronal deformity and ligamentous laxity [11,12,15,[18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Recent investigations reveal that using CCK prosthesis in primary TKA would not be detrimental to the patient and provides similar outcomes compared with PS prosthesis [7,8]. Even so, it is generally avoided because of its higher cost, the complexity of the procedure, and greater bone removal [9]. Therefore, the implications of CCK prosthesis should be restricted to the patients who have indications.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Clinical Correctability and Prediction of the Prosthesis Type in Total Knee Arthroplasty for ‌Severe Osteoarthritic Varus Deformity

Shahpari

Bagherifard

Rahbar

et al. 2019

J. Res. Orthop. Sci.

View full text Add to dashboard Cite

Background: The preoperative identification of patients who might need constrained condylar knee (CCK) prosthesis in total knee arthroplasty (TKA), is essential to ensure the availability of equipment and to address the patients’ expectations accurately. Objectives: In this study, we aimed at investigating if the preoperative features of the patients can provide this data. Methods: A total of 30 patients who underwent primary TKA for severe osteoarthritic genu varum deformity (varus angle ≥20º) were evaluated in this retrospective study. Prosthesis selection was based on preoperative and intraoperative information. Demographic data, preoperative correctability of the deformity, and intraoperative information, including the reduction osteotomy, soft-tissue release, and pie-crust technique, were retrospectively collected. Soft-tissue release was performed in a sequential manner in 3 steps. Results: The study population included 4 males and 26 females with a mean±SD age of 64.6±8.7 years. A CCK prosthesis was used in 11 (36.7%) cases. A significant association was found between the preoperative correctability and the type of prosthesis. In other words, all CCK prostheses were used in patients who were preoperatively non-correctable (P<0.001). Also, the step of release was significantly associated with the type of prosthesis, and CCK prosthesis was used in all patients with step 3 release (P<0.001). Preoperative correctability was significantly related to the step of release, as well. It means that all deformities with step 3 release were preoperatively non-correctable (P=0.008). Conclusion: The preoperative clinical evaluation of correctability could be used in the identification of patients who might need a CCK prosthesis.

show abstract

Good to excellent long-term survival of a single-design condylar constrained knee arthroplasty for primary and revision surgery

Theil

Schwarze

Gosheger

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose The purpose of the study was to determine the long-term survivorship, functional outcomes of a single-design condylar constrained (CCK) TKA in primary and revision cases as well as to assess specific risk factors for failure. It was hypothesized that primary CCK TKA had a better survival than revision knees. Methods One hundred and forty three patients who underwent revision TKA (n = 119) or complex primary TKA (n = 24) using a single-design condylar constrained knee system (Genesis CCK, Smith & Nephew) performed at a single institution between 1999 and 2008 were retrospectively included. The median follow-up amounted to 11.8 years (IQR 10.3–14.4). Implant survivorship was analyzed using Kaplan–Meier survival estimates and multivariate Cox regression analysis to identify risk factors for failure. Function was determined using the Oxford Knee Score (OKS). Results The implant survival was 86.4% after five, 85.5% after ten and 79.8% at 15 years. A reduced implant survivorship was found in males (HR 5.16, p = 0.001), smokers (HR 6.53, p = 0.004) and in obese patients (HR 2.26, p = 0.095). Patients who underwent primary TKA had a higher revision-free implant survivorship compared to revision TKA at 15 years (100% vs. 76%, p = 0.036). The main cause for re-revision was infection in 10% of all revision TKA performed with the CCK design included, while no case was revised for instability. The median OKS was 39 (IQR 35–44) in 102 patients available for long-term functional outcome. Conclusion CCK implants are associated with excellent long-term survival when used in primary TKA; however, survival was worse when used during revision TKA. Males, smokers, obese patients and are at higher risk for revision. While instability and aseptic loosening were rare, infection remains a major concern. Level of evidence Level IV, retrospective observational study.

show abstract

Clinical and Functional Outcomes: Primary Constrained Condylar Knee Arthroplasty Compared With Posterior Stabilized Knee Arthroplasty

Abstract: Primary constrained condylar knee arthroplasty does not affect clinical and functional outcomes at 2 years when compared with posterior stabilized knee arthroplasty.

Cited by 17 publications

References 22 publications

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

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

Preoperative Clinical Correctability and Prediction of the Prosthesis Type in Total Knee Arthroplasty for ‌Severe Osteoarthritic Varus Deformity

Good to excellent long-term survival of a single-design condylar constrained knee arthroplasty for primary and revision surgery

Contact Info

Product

Resources

About