The Utility of Increased Constraint in Primary Total Knee Arthroplasty for Obese Patients

Tripathi, Mohan S.; Heinle, Colin C.; Manaqibwala, Moiz I.; Tria, Alfred J.

doi:10.1016/j.ocl.2015.08.007

Cited by 13 publications

(3 citation statements)

References 15 publications

(13 reference statements)

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“…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%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 90%

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

et al. 2020

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“…Wilke et al 5 reported similar findings, with a 10‐year survival rate of 80% in aseptic revisions. This confirms the excellent outcomes achieved in primary arthroplasties, good outcomes in aseptic revisions, and regular outcomes in septic revisions 25–27 . Recent clinical studies in rotating hinged implants show similar survival results 20,28–30 …”

Section: Discussionsupporting

confidence: 65%

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

León-Román¹,

García-Mato

López-Torres

et al. 2020

Journal Orthopaedic Research

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The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses (CCK) is a matter of discussion in revision knee arthroplasty. The objectives of this study are to compare the tibial rotation of both implants and validate the use of inertial sensors with optical tracking system as movement measurement tools. A total of 16 cadaver knees were used. Eight knees were replaced using a RHK (Endomodel LINK), and the remaining eight received a CCK prosthesis (LCCK, Zimmer). Tibial rotation range of motion was measured in full extension and at 30°, 60°, and 90° of flexion, with four continuous waveforms for each measurement. Measurements were made using two inertial sensors with specific software and compared with measurements obtained using the gold standard technique ‐ the motion capture camera. The comparison of the accuracy of both measurement methods showed no statistically significant differences between inertial sensors and motion capture cameras, with p > .1; the mean error for tibial rotation was 0.21°. Tibial rotation in the RHK was significantly greater than in the CCK (5.25° vs. 2.28°, respectively), p < .05. We have shown that RHK permit greater tibial rotation, being closer to physiological values than CCKs. Inertial sensors have been validated as an effective and accurate method of measuring knee movement. The clinical significance: RHK appears to represent a lower constriction degree than CCK systems.

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“…Similar results were obtained in obese patients who received the CCK prosthesis to gain increased stability. 7 Hence, we cannot recommend the routine use of the CCK prosthesis, with its associated increased implant cost, complexity of the procedure, and greater bone removal, for the explicit purpose of improving range of motion and functional outcome scores in the setting of primary knee arthroplasty compared with a PS prosthesis. Conversely, the use of a CCK prosthesis, if indicated, because of preoperative or intraoperative instability or difficult ligament balancing would not be detrimental to the patient, given the similar outcomes between both groups of patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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The Utility of Increased Constraint in Primary Total Knee Arthroplasty for Obese Patients

Cited by 13 publications

References 15 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

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

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

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