The knee prosthesis constraint dilemma: Biomechanical comparison between varus‐valgus constrained implants and rotating hinge prosthesis. A cadaver study

León-Román, Víctor Estuardo; García-Mato, David; López-Torres, Irene Isabel; Vaquero-Martín, F J; Calvo-Haro, José Antonio; Pascau, Javier; Sanz-Ruíz, Pablo

doi:10.1002/jor.24844

Cited by 7 publications

(4 citation statements)

References 39 publications

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“…Rotating hinge prosthesis could provide better three‐dimensional freedom, and has been more frequently chosen for TKA to treat Charcot knee in the last 10 years (Figure 2 ). 20 , 21 Recently, more studies 5 , 6 , 9 , 10 , 22 , 23 , 24 , 25 , 26 , 27 , 28 reported the use of condylar constrained prostheses and rotating hinge prostheses with satisfied results for TKA in Charcot knee.…”

Section: Discussionmentioning

confidence: 99%

Constrained Condylar Prostheses for the Treatment of Charcot Arthropathy: A Case Report and Literature Review

Mei

Lin

et al. 2023

Orthopaedic Surgery

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Background Neuroarthropathy of the knee or Charcot knee, leading to chronic joint destruction, is a rare disease that is difficult to diagnose. The treatment of this condition is difficult and controversial. Case Presentation A 74‐year‐old Asian woman has had bilateral knee pain for 22 years and deformity for 10 years, which has been aggravating for 2 months. Physical examination showed bilateral knee varus deformity greater than 15°, and −20 to 90° range of motion. X‐ray revealed bilateral varus deformity with massive free body hyperplasia. Combined with medical history as syringomyelia, the patient was diagnosed with bilateral Charcot knees and bilateral joint replacements were performed using Legacy Constrained Condylar Knee prostheses (LCCK; Zimmer, USA). The patient reported satisfactory treatment outcomes, pain relief, and improved range of motion in both knees, without postoperative complications or prosthesis loosening at 2 year after operation. Conclusions Total knee arthroplasty (TKA) may be considered a viable option for treating the Charcot knee. The use of constrained condylar prostheses can produce satisfactory results. Attention should be given to survival risks, complications, and other potential determining factors associated with TKA when devising a treatment strategy for the Charcot knee.

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Section: Discussionmentioning

confidence: 99%

Constrained Condylar Prostheses for the Treatment of Charcot Arthropathy: A Case Report and Literature Review

Mei

Lin

et al. 2023

Orthopaedic Surgery

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“…However, the introduction of the newer third‐generation RHK allows more rotational freedom, and therefore reduces the constraint in the axial plane [5]. Consequently, a CCK can lead to more constraint in the axial plane compared to an RHK [18], which is investigated by recent cadaver and biomechanical studies demonstrating that some RHK implants (RT‐Plus RHK [7], Zimmer [23], Endomodel LINK [24]) were prone to less stress shear at the bone–implant interface compared to the CCK implant [7, 23, 24]. However, an RHK remains more constrained in the coronal plane compared to a CCK, as the CCK design offers less rigidity during varus–valgus movements [2].…”

Section: Discussionmentioning

confidence: 99%

Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta‐analysis

Stroobant,

de Taeye,

Byttebier

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA. Methods Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component. Results A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°). Conclusion This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated. Level of evidence IV.

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“…During rTKA, using more constrained implants, such as VVC and hinged prostheses, require femoral and tibial stems [ 3 , 9 ]. Stems have a load-sharing capability, increase initial femoral and tibial component stability, and aid the remaining damaged or absent metaphyseal bone to deal with excessive stress [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

How often do we need offset stems for revision total knee arthroplasty? About a consecutive series of 789 knees

Vasiliadis

Lording

Canetti

et al. 2023

SICOT-J

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Introduction: This study aimed to determine the incidence of offset stem usage in revision total knee arthroplasty (rTKA), and to assess the necessity for their use with the femoral and tibial components. Methods: This retrospective radiological study included 862 patients who underwent rTKA between 2010 and 2022. Patients were divided into a non-stem group (group NS), offset stem group (group OS), and straight stem group (group SS). Two senior orthopedic surgeons evaluated all the post-operative radiographs of the group OS to assess the necessity of offset use. Results: In total, 789 patients met all eligibility inclusion criteria and were reviewed (305 males (38.7%)) with a mean age of 72.7 ± 10.2 years old [39; 96]. Eighty-eight (11.1%) patients had undergone rTKA with offset stems (34 tibia, 31 femur, 24 both) and 609 (70.2%) with straight stems. The tibial and femoral stems were diaphyseal of over 75 mm in 83 revisions (94.3%) for group OS and 444 revisions (72.9%) for group SS (p < 0.001). Offset in the tibial component was located medially in 50% of rTKA, while the offset in the femoral component was placed anteriorly in 47.3% of the rTKA. Assessment by the two independent senior surgeons found stems were only necessary in 3.4% of cases. Offset stems were only required for the tibial implant. Discussion: Offset stems were used in 11.1% of revision total knee replacements, however, they were deemed necessary in 3.4% and for the tibial component only.

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The knee prosthesis constraint dilemma: Biomechanical comparison between varus‐valgus constrained implants and rotating hinge prosthesis. A cadaver study

Cited by 7 publications

References 39 publications

Constrained Condylar Prostheses for the Treatment of Charcot Arthropathy: A Case Report and Literature Review

Constrained Condylar Prostheses for the Treatment of Charcot Arthropathy: A Case Report and Literature Review

Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta‐analysis

How often do we need offset stems for revision total knee arthroplasty? About a consecutive series of 789 knees

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