Total Knee Arthroplasty in Coronal Deformities > 15°: Comparison of Short-term Outcomes between Primary and Semi-constrained Implants

Abstract

Objective To compare the clinical and radiological patient outcomes with varus-valgus knee deformities undergoing knee replacement with posterior stabilized (PS) prostheses versus semi-constrained condylar knee (CCK) implants.

Methods Retrospective study of patients with mechanical alignment (MA) > 15°, undergoing PS or CCK. All the procedures were done in the same center between 2014-2018. The decision was determined by clinical, radiological, and intraoperative parameters. Patients with incomplete data and follow-ups of less than one year were excluded. Patient demographic data, pre- and postoperative deformity, range of motion (ROM), complications, and functional outcomes were evaluated from the database.

Results 39 patients met the selection criteria. PS group: 27 patients, mean age of 69 years [49-82]; 59.3% varus and 40.7% valgus. CCK group: 12 patients, mean age of 69.3 years [41-89]; 33.3% varus and 66.7% valgus. The groups had no significant differences regarding demographic data or MA between the groups (p = 0.07). Average follow-up: PS = 49,1 months; CCK = 22 months. The KOOS score was 74.1 for PS and 85.2 for CCK (p > 0,05). WOMAC score was significantly better for the CCK group. The average postoperative ROM was PS = active: 1,9°-101°; passive: 1,6°-108,4° /CCK = active: 2,5-110°, passive: 1,9-117°. Significant differences in active (p = 0.03) and passive (p = 0.04) flexion were observed. The MA correction was PS = 14,9 [3°-31°] / CCK = 19° [13°-28°] (p = 0.09). No infectious or thromboembolic postoperative complications were reported.

Conclusion PS and CCK implants are valid options for patients with coronal deformities >15°. At almost two years of follow-up, the WOMAC Score and flexion significantly improved outcomes with the CCK implant.

Level of evidence IV.

Keywords

knee - knee replacement - severe deformity - semi-constrained - primary replacement - Primary replacement

Publikationsverlauf

Eingereicht: 05. Oktober 2022

Angenommen: 01. Juli 2024

Artikel online veröffentlicht:
25. September 2024

• Referencias

• 1 Donaldson III WF, Sculco TP, Insall JN, Ranawat CS. Total condylar III knee prosthesis. Long-term follow-up study. Clin Orthop Relat Res 1988; (226) 21-28
• 2 Barahona M, Barrientos C, Escobar Sr F. et al. Trends in Knee and Hip Arthroplasty in Chile Between 2004 and 2019. Cureus 2020; 12 (12) e12185
• 3 Sculco TP. The role of constraint in total knee arthoplasty. J Arthroplasty 2006; 21 (4, Suppl 1) 54-56
• 4 Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 315-318
• 5 Long W, Scuderi G. Varus and Valgus Deformities. En: Pagnano M, Hanssen A. Master Technique in Orthopedic Surgery: Knee Arthroplasty. Cuarta Edición. Philadelphia:: Wolters Kluwer;; 2019: 304-337
• 6 De Muylder J, Victor J, Cornu O, Kaminski L, Thienpont E. Total knee arthroplasty in patients with substantial deformities using primary knee components. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3653-3659
• 7 Easley ME, Insall JN, Scuderi GR, Bullek DD. Primary constrained condylar knee arthroplasty for the arthritic valgus knee. Clin Orthop Relat Res 2000; (380) 58-64
• 8 Anderson JA, Baldini A, MacDonald JH, Pellicci PM, Sculco TP. Primary constrained condylar knee arthroplasty without stem extensions for the valgus knee. Clin Orthop Relat Res 2006; 442 (442) 199-203
• 9 Cholewinski P, Putman S, Vasseur L. et al. Long-term outcomes of primary constrained condylar knee arthroplasty. Orthop Traumatol Surg Res 2015; 101 (04) 449-454
• 10 Mancino F, Falez F, Mocini F, Sculco PK, Maccauro G, De Martino I. Is varus-valgus constraint a reliable option in complex primary total knee arthroplasty? A systematic review. J Orthop 2021; 24: 201-211
• 11 Cinotti G, Perfetti F, Petitti P, Giannicola G. Primary complex total knee arthroplasty with severe varus deformity and large bone defects: mid-term results of a consecutive series treated with primary implants. Eur J Orthop Surg Traumatol 2022; 32 (06) 1045-1053
• 12 Martin JR, Beahrs TR, Stuhlman CR, Trousdale RT. Complex Primary Total Knee Arthroplasty: Long-Term Outcomes. J Bone Joint Surg Am 2016; 98 (17) 1459-1470
• 13 Morgan H, Battista V, Leopold SS. Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg 2005; 13 (08) 515-524
• 14 Park CH, Bae JK, Song SJ. Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty. Int Orthop 2019; 43 (08) 1831-1840
• 15 Pang HN, Bin Abd Razak HR, Jamieson P, Teeter MG, Naudie DDR, MacDonald SJ. Factors Affecting Wear of Constrained Polyethylene Tibial Inserts in Total Knee Arthroplasty. J Arthroplasty 2016; 31 (06) 1340-1345
• 16 Mullaji AB, Padmanabhan V, Jindal G. Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplasty 2005; 20 (05) 550-561
• 17 Laskin RS. The Insall Award. Total knee replacement with posterior cruciate ligament retention in patients with a fixed varus deformity. Clin Orthop Relat Res 1996; (331) 29-34
• 18 Pang HN, Yeo SJ, Chong HC, Chin PL, Chia SL, Lo NN. Joint line changes and outcomes in constrained versus unconstrained total knee arthroplasty for the type II valgus knee. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2363-2369
• 19 Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012; 470 (01) 45-53
• 20 Lizaur-Utilla A, Miralles-Muñoz FA, Gonzalez-Parreño S, López-Prats FA. Validation of the Spanish Version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for Elderly Patients With Total Knee Replacement. J Orthop Res 2019; 37 (10) 2157-2162
• 21 Gómez-Valero S, García-Pérez F, Flórez-García MT, Miangolarra-Page JC. A systematic review of self-administered questionnaires for the functional assessment of patients with knee disabilities adapted into Spanish. Rev Esp Cir Ortop Traumatol 2017; 61 (02) 96-103
• 22 Koninckx A, Schwab PE, Deltour A, Thienpont E. The minimally invasive far medial subvastus approach for total knee arthroplasty in valgus knees. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1765-1770
• 23 Mullaji AB, Shetty GM, Kanna R, Vadapalli RC. The influence of preoperative deformity on valgus correction angle: an analysis of 503 total knee arthroplasties. J Arthroplasty 2013; 28 (01) 20-27
• 24 Shi X, Li H, Zhou Z. et al. Individual valgus correction angle improves accuracy of postoperative limb alignment restoration after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (01) 277-283
• 25 Alghamdi A, Rahmé M, Lavigne M, Massé V, Vendittoli PA. Tibia valga morphology in osteoarthritic knees: importance of preoperative full limb radiographs in total knee arthroplasty. J Arthroplasty 2014; 29 (08) 1671-1676
• 26 Palanisami D, Jagdishbhai CP, Manohar M, Ramesh P, Natesan R, Shanmuganathan R. Improving the accuracy of tibial component placement during total knee replacement in varus knees with tibial bowing: A prospective randomised controlled study. Knee 2019; 26 (05) 1088-1095
• 27 Bellemans J, Vandenneucker H, Van Lauwe J, Victor J. A new surgical technique for medial collateral ligament balancing: multiple needle puncturing. J Arthroplasty 2010; 25 (07) 1151-1156
• 28 Rai S, Liu X, Feng X. et al. Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis. J Orthop Surg Res 2018; 13 (01) 67
• 29 Maynard LM, Sauber TJ, Kostopoulos VK, Lavigne GS, Sewecke JJ, Sotereanos NG. Survival of primary condylar-constrained total knee arthroplasty at a minimum of 7 years. J Arthroplasty 2014; 29 (06) 1197-1201
• 30 Lachiewicz PF, Soileau ES. Ten-year survival and clinical results of constrained components in primary total knee arthroplasty. J Arthroplasty 2006; 21 (06) 803-808
• 31 Lanting BA, Snider MG, Chess DG. Effect of polyethylene component thickness on range of motion and stability in primary total knee arthroplasty. Orthopedics 2012; 35 (02) e170-e174
• 32 Nam D, Umunna BP, Cross MB, Reinhardt KR, Duggal S, Cornell CN. Clinical results and failure mechanisms of a nonmodular constrained knee without stem extensions. HSS J 2012; 8 (02) 96-102