Ten-Year Results of Primary and Revision Condylar-Constrained Total Knee Arthroplasty in Patients with Severe Coronal Plane Instability

Abstract

Objective :To retrospectively review the results at minimum ten years after surgery of a consecutive series of total knee arthroplasties (TKAs) performed using a constrained condylar implant in patients with severe coronal plane instability.Materials and Methods :The series comprised of 44 patients (45 knees) who received primary (19 knees) or revision (26 knees) TKA with a constrained condylar implant between 2001 and 2003 at a single institution.Results :There were no revisions or any other surgery related complications at a mean implantation time of 11.0 years. In 38 patients (15 knees in the primary group and 24 knees in the revision group) who were available for clinico-radiographic follow-up at a minimum of ten years, there was no sign of radiographic loosening. Two patients showed cortical hypertrophy at the extension stem tip but none complained of pain around the stem tip.According to the TLKSS score grading, 73% of the patients in the primary group had results categorized as good or excellent, while 54% of the patients in the revision group had fair results. Four patients (one (7%) in the primary group and three (13%) in the revision group) had poor results. The median WOMAC Index was 80.2% (interquartile range: 74.0% - 81.2%) and 74.0% (interquartile range: 72.1% - 75.8%) in the primary and in the revision groups, respectively (p=0.010).Conclusion :This study showed satisfactory clinical outcomes with no re-operations at minimum ten years after implantation in patients who had undergone primary or revision TKA with a condylar constrained implant.

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

“…Previous studies have reported greater residual pain for multiplane instability than other instabilities after surgery, indicating postoperative residual pain with RHK prostheses. [ 6 , 26 ] Furthermore, there were some interesting findings in a study by Shen et al [ 18 ] that CCK prostheses had superior clinical and functional scores when used in aseptic AORI II or III bone loss, whereas patients in septic AORI II or III bone loss had better outcomes with RHK prostheses. It is possible that a more constrained prosthesis is needed in septic revision for better clinical and functional outcomes because prosthetic RHK designs allow much more aggressive capsuloligament debridement and thus more adequate infection eradication.…”

“…[ 5 ] However, there are concerns with CCK implants; they cannot be used in all cases with high degrees of anteroposterior instability, flexion-extension gap mismatch, non-reconstructable collateral ligaments, and extensor mechanism insufficiency. [ 6 ] Although many studies have reported the clinical outcome and survivorships of patients who underwent RTKA with one of the two implants, few comparative studies exist and only one meta-analysis. [ 4 ] Published studies have not dealt with subgroup analysis regarding short-term and midterm survivorships and factors that affect survivorship of the two implants.…”

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

“… 8 , 9 However, long-term follow-up studies of patients with the CCK prosthesis used in primary total knee arthroplasty have shown favorable implant survival of up to 10 years. 9 10 11 12 13 14 15 The greater amount of bone resected for the implantation of a CCK prosthesis, with the use of more augments and possibly greater constraint, would make revision surgery more technically challenging compared with that of a PS prosthesis. 16 The two patients who sustained intraoperative fractures of the lateral femoral condyle in the CCK group highlight the inherent risks and technical challenges in the use of the CCK implant, possibly because of the larger box cut required.…”

Mid-term results and survival rates following a single-design rotating hinge knee arthroplasty in non-tumor conditions in a Pakistani population

“…In this situation, a hinged knee implant or constrained condylar knee (CCK) could be considered. To address global instability during knee arthroplasty, the hinged implant is preferred because of concerns associated with constrained condylar knees as a CCK implant cannot overcome severe antero-posterior instability and collateral insufficiency [ 6 , 7 ]. Knee stability is mainly controlled by muscles, ligaments and articular congruence.…”