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International Orthopaedics

, Volume 43, Issue 8, pp 1831–1840 | Cite as

Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty

  • Cheol Hee Park
  • Jung Kwon Bae
  • Sang Jun SongEmail author
Original Paper
  • 162 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Knee Arthroplasty Revision Constraint 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 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 CrossRefPubMedGoogle Scholar
  2. 2.
    Nedopil AJ, Howell SM, Hull ML (2017) What mechanisms are associated with tibial component failure after kinematically-aligned total knee arthroplasty? Int Orthop 41(8):1561–1569.  https://doi.org/10.1007/s00264-017-3490-6 CrossRefGoogle Scholar
  3. 3.
    Shen C, Lichstein PM, Austin MS, Sharkey PF, Parvizi J (2014) Revision knee arthroplasty for bone loss: choosing the right degree of constraint. J Arthroplast 29(1):127–131.  https://doi.org/10.1016/j.arth.2013.04.042 CrossRefGoogle Scholar
  4. 4.
    Kim YH, Park JW, Kim JS, Oh HK (2015) Long-term clinical outcomes and survivorship of revision Total knee arthroplasty with use of a constrained condylar knee prosthesis. J Arthroplast 30(10):1804–1809.  https://doi.org/10.1016/j.arth.2015.04.019 CrossRefGoogle Scholar
  5. 5.
    Lee KJ, Bae KC, Cho CH, Son ES, Jung JW (2016) Radiological stability after revision of infected Total knee arthroplasty using modular metal augments. Knee Surg Relat Res 28(1):55–61.  https://doi.org/10.5792/ksrr.2016.28.1.55 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Shon OJ, Lee DC, Ryu SM, Ahn HS (2016) Comparison of difference in hematologic and hemodynamic outcomes between primary Total knee arthroplasty and revision of infected Total knee arthroplasty. Knee Surg Relat Res 28(2):130–136.  https://doi.org/10.5792/ksrr.2016.28.2.130 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Touzopoulos P, Drosos GI, Ververidis A, Kazakos K (2015) Constrained implants in Total knee replacement. Surg Technol Int 26:307–316PubMedGoogle Scholar
  8. 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. 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
  10. 10.
    Gustke KA (2005) Preoperative planning for revision total knee arthroplasty:avoiding chaos. J Arthroplast 20(4 Suppl 2):37–40CrossRefGoogle Scholar
  11. 11.
    Haas SB, Insall JN, Montgomery W, 3rd, Windsor RE (1995) Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg Am 77(11):1700–1707CrossRefPubMedGoogle Scholar
  12. 12.
    Hossain F, Patel S, Haddad FS (2010) Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res 468(5):1221–1228.  https://doi.org/10.1007/s11999-009-1204-0 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lau AC, Howard JL, Macdonald SJ, Teeter MG, Lanting BA (2016) The effect of subluxation of articulating antibiotic spacers on bone defects and degree of constraint in revision knee arthroplasty. J Arthroplast 31(1):199–203.  https://doi.org/10.1016/j.arth.2015.07.009 CrossRefGoogle Scholar
  14. 14.
    Lee JK, Lee S, Kim D, Lee SM, Jang J, Seong SC, Lee MC (2013) Revision total knee arthroplasty with varus-valgus constrained prosthesis versus posterior stabilized prosthesis. Knee Surg Sports Traumatol Arthrosc 21(3):620–628.  https://doi.org/10.1007/s00167-012-1998-2 CrossRefPubMedGoogle Scholar
  15. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Worhacz K, Jacofsky MC, Jacofsky DJ, Ahmed S (2018) Comparing the efficacy of the total stabilizing and posterior stabilizing knee prostheses in obese and preobese females: a retrospective cohort study. J Knee Surg 31(9):884–888.  https://doi.org/10.1055/s-0037-1615802 CrossRefPubMedGoogle Scholar
  17. 17.
    Cabral F, Sousa-Pinto B, Pinto R, Torres J (2017) Patellar height after total knee arthroplasty: comparison of 3 methods. J Arthroplast 32(2):552–557 e552.  https://doi.org/10.1016/j.arth.2016.07.013 CrossRefGoogle Scholar
  18. 18.
    Panegrossi G, Ceretti M, Papalia M, Casella F, Favetti F, Falez F (2014) Bone loss management in total knee revision surgery. Int Orthop 38(2):419–427.  https://doi.org/10.1007/s00264-013-2262-1 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Vasso M, Beaufils P, Schiavone Panni A (2013) Constraint choice in revision knee arthroplasty. Int Orthop 37(7):1279–1284.  https://doi.org/10.1007/s00264-013-1929-y CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Peters CL, Hennessey R, Barden RM, Galante JO, Rosenberg AG (1997) Revision total knee arthroplasty with a cemented posterior-stabilized or constrained condylar prosthesis: a minimum 3-year and average 5-year follow-up study. J Arthroplast 12(8):896–903CrossRefGoogle Scholar
  21. 21.
    Pang HN, Bin Abd Razak HR, Jamieson P, Teeter MG, Naudie DDR, MacDonald SJ (2016) Factors affecting Wear of constrained polyethylene tibial inserts in Total knee arthroplasty. J Arthroplast 31(6):1340–1345.  https://doi.org/10.1016/j.arth.2015.12.011 CrossRefGoogle Scholar
  22. 22.
    Cholewinski P, Putman S, Vasseur L, Migaud H, Duhamel A, Behal H, Pasquier G (2015) Long-term outcomes of primary constrained condylar knee arthroplasty. Orthop Traumatol Surg Res 101(4):449–454.  https://doi.org/10.1016/j.otsr.2015.01.020 CrossRefPubMedGoogle Scholar
  23. 23.
    Berend ME, Bertrand T (2007) The role of implant constraint: not too little, not too much. Orthopedics 30(9):793–794PubMedGoogle Scholar
  24. 24.
    Song SJ, Detch RC, Maloney WJ, Goodman SB, Huddleston JI 3rd (2014) Causes of instability after total knee arthroplasty. J Arthroplast 29(2):360–364.  https://doi.org/10.1016/j.arth.2013.06.023 CrossRefGoogle Scholar
  25. 25.
    Indelli PF, Giori N, Maloney W (2015) Level of constraint in revision knee arthroplasty. Curr Rev Musculoskelet Med 8(4):390–397.  https://doi.org/10.1007/s12178-015-9295-6 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Prudhon JL, Caton JH, Aslanian T, Verdier R (2018) How is patella height modified after total knee arthroplasty? Int Orthop 42(2):311–316.  https://doi.org/10.1007/s00264-017-3539-6 CrossRefPubMedGoogle Scholar
  27. 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
  28. 28.
    Koh IJ, Kim TK, Chang CB, Cho HJ, In Y (2013) Trends in use of total knee arthroplasty in Korea from 2001 to 2010. Clin Orthop Relat Res 471(5):1441–1450.  https://doi.org/10.1007/s11999-012-2622-y CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Medicine, Graduate SchoolKyung Hee UniversitySeoulSouth Korea
  2. 2.Department of Orthopaedic Surgery, College of MedicineKyung Hee UniversitySeoulSouth Korea

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