Increased utilization of constraint in total knee arthroplasty following anterior cruciate ligament and multiligament knee reconstruction

Abstract

Aims Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There are limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) versus a matched cohort of patients undergoing TKA with no history of PKLR. Patients and Methods Patients with a history of ACL or MLK reconstruction who underwent TKA between 2007 and 2017 were identified in a single-institution registry. There were 223 patients who met inclusion criteria (188 ACL reconstruction patients, 35 MLK reconstruction patients). A matched cohort, also of 223 patients, was identified based on patient age, body mass index (BMI), sex, and year of surgery. There were 144 male patients and 79 female patients in both cohorts. Mean age at the time of TKA was 57.2 years (31 to 88). Mean BMI was 29.7 kg/m2 (19.5 to 55.7). Results There was a significantly higher use of constrained implants among patients with PKLR (76 of 223, 34.1%) compared with the control group (40 of 223, 17.9%; p < 0.001). Subgroup analysis showed a higher use of constrained implants among patients with prior MLK reconstruction (21 of 35, 60.0%) compared with ACL reconstruction (55 of 188, 29.3%; p < 0.001). Removal of hardware was performed in 69.5% of patients with PKLR. Mean operative time (p < 0.001) and tourniquet time (p < 0.001) were longer in patients with PKLR compared with controls. There were no significant differences in rates of deep vein thrombosis, pulmonary embolism, infection, transfusion, postoperative knee range of movement (ROM), or need for revision surgery. There was no significant difference in preoperative or postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) scores between groups. Conclusion Results of this study suggest a history of PKLR results in increased use of constrained implants but no difference in postoperative knee ROM, patient-reported outcomes, or incidence of revision surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):77–83

Total Knee Arthroplasty after Anterior Cruciate Ligament Reconstruction

“…30 The authors did not find any difference between groups in postoperative knee ROM, patient-reported outcomes, or incidence of revision surgery. 30…”

“…James et al analyzed 188 patients with prior ACL reconstruction and 35 patients with prior multiligament reconstruction who underwent TKA, and found they had a significantly higher use of constrained implants at the time of TKA when compared with controls without prior ligament reconstruction. 30 The authors did not find any difference between groups in postoperative knee ROM, patientreported outcomes, or incidence of revision surgery. 30 Finally, further study is needed to determine if differences between old and new ACL fixation implants have effect on subsequent TKA.…”

“…30 The authors did not find any difference between groups in postoperative knee ROM, patientreported outcomes, or incidence of revision surgery. 30 Finally, further study is needed to determine if differences between old and new ACL fixation implants have effect on subsequent TKA. Several studies show increased operative time for removal and increased technical difficulty due to retained hardware from prior ACL reconstruction.…”

Conversion Total Knee Arthroplasty

“…Although several authors have reported no increase in complications for ACL-TKA compared with primary TKA, others have noted increased complication rates 9-12,14 . Watters et al found that the risk of reoperation in patients undergoing ACL-TKA was 5.5 times higher than that for patients undergoing primary TKA 10 .…”

“…The use of constrained implants increases with the complexity of prior ligament reconstruction. James et al compared 223 patients who had undergone previous ACL or multiligamentous knee reconstruction with a matched cohort of 223 patients who underwent primary TKA 14 . Constrained implants were used in 17.9% of patients who underwent primary TKA, 29.3% of patients who underwent ACL-TKA, and 60.0% of patients who underwent conversion TKA after multiligamentous reconstruction 14 .…”