Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty
- 135 Downloads
The purposes of the present study were to assess the levels of prosthetic constraint chosen during revision total knee arthroplasty (TKA) and to identify factors influencing the choice of a constrained prosthesis.
We retrospectively reviewed data on 274 revision TKAs. The mean follow-up period after revision TKA was 7.2 years. The femorotibial angle (FTA), joint line height (JLH), and Insall–Salvati ratio (ISR) were radiographically evaluated. Factors affecting the extent of constraint chosen were evaluated in terms of age, gender, body mass index, primary diagnosis, the cause of revision TKA, the Anderson Orthopedic Research Institute (AORI) classification, and changes in the JLH and ISR.
Totals of 247 (90.1%), 11 (4.0%), and 9 (3.4%) knees received posteriorly stabilized prostheses, constrained condylar knees, and rotating hinge prostheses, respectively. On multivariate analysis, the cause of revision TKA including loosening and instability and the changes in the JLH and ISR affected independently the choice of a constrained prosthesis.
The frequency of implantation of constrained prostheses was 7.4% in the present study. Consideration of various factors including the cause of revision TKA and changes in the JLH and ISR will aid the TKA surgeon in selecting prostheses with appropriate constraints when performing revision TKAs.
KeywordsKnee Arthroplasty Revision Constraint
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Hernigou P, Dubory A, Potage D, Roubineau F, Flouzat-Lachaniette CH (2017) Outcome of knee revisions for osteoarthritis and inflammatory arthritis with postero-stabilized arthroplasties: a mean ten-year follow-up with 90 knee revisions. Int Orthop 41(4):757–763. https://doi.org/10.1007/s00264-016-3319-8 CrossRefGoogle Scholar
- 7.Touzopoulos P, Drosos GI, Ververidis A, Kazakos K (2015) Constrained implants in Total knee replacement. Surg Technol Int 26:307–316Google Scholar
- 8.Samiezadeh S, Bougherara H, Abolghasemian M, D'Lima D, Backstein D (2018) Rotating hinge knee causes lower bone-implant interface stress compared to constrained condylar knee replacement. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5054-8
- 9.Wang X, Malik A, Bartel DL, Wright TM, Padgett DE (2016) Load sharing among collateral ligaments, articular surfaces, and the tibial post in constrained condylar knee arthroplasty. J Biomech Eng 138(8). https://doi.org/10.1115/1.4033678
- 15.Hwang SC, Kong JY, Nam DC, Kim DH, Park HB, Jeong ST, Cho SH (2010) Revision total knee arthroplasty with a cemented posterior stabilized, condylar constrained or fully constrained prosthesis: a minimum 2-year follow-up analysis. Clin Orthop Surg 2(2):112–120. https://doi.org/10.4055/cios.2010.2.2.112 CrossRefGoogle Scholar
- 23.Berend ME, Bertrand T (2007) The role of implant constraint: not too little, not too much. Orthopedics 30(9):793–794Google Scholar
- 27.Boelch SP, Arnholdt J, Holzapfel BM, Jakuscheit A, Rudert M, Hoberg M (2018) Revision knee arthroplasty with rotating hinge systems in patients with gross ligament instability. Int Orthop. https://doi.org/10.1007/s00264-018-3982-z