Constraint choice in revision knee arthroplasty

Abstract

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.

Primary modular total knee replacement in severe and unstable osteoarthritis. Predictive factors for failure

“…In relation to the demographic characteristics of our study population, the average ages of our groups are somewhat higher than primary knee arthroplasty studies reported by Vasso et al [10], Deshmukh et al [11], Lachiewicz and Fatalyn [12], Anderson et al [13], Asif and Choon [18], Kane et al [21], Robinson [22], García-Crespo et al [21], Thelu et al [24], Abbas and Gunn [25] and Nakama et al [26] in the literature. Our patients had average ages of 70.5 years and nearly 61 % were older than 65 years.…”

“…Hinge prosthesis as primary implant is restricted to treat tumoural pathologies. Similar algorithms have been published recently to facilitate the appropriate choice of prosthesis constraint in knee replacement [10].…”

Revision knee surgery techniques

“…2 CCK systems are generally indicated in patients with intermediate ligamentous insufficiency and moderate bone loss, whereas RH systems are required in the presence of complete disruption of the ligaments and/or severe bone loss. 45 …”

Constraints in total knee arthroplasty: current status and review of literature

“…34 Prostheses implanted at revision included PS, CCK and RHK. Constraint choice for the revision prosthesis depended on the state of the ligaments and on the severity of bone loss according to AORI (Anderson Orthopaedic Research Institute) classification.…”