The impact of posterior-stabilized vs. constrained polyethylene liners in revision total knee arthroplasty.
Constrained liners
Outcomes
Posterior-stabilized liners
Revision
Total knee arthroplasty
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
15
06
2022
accepted:
18
09
2022
pubmed:
1
10
2022
medline:
16
2
2023
entrez:
30
9
2022
Statut:
ppublish
Résumé
Posterior stabilized (PS) and varus valgus constrained (VVC) knee polyethylene liners have been shown to confer excellent long-term functional results following revision total knee arthroplasty (rTKA). The purpose of this study was to compare outcomes of patients who underwent rTKA using either a PS or VVC liner. A retrospective comparative study of 314 rTKA with either PS or VVC liner and a minimum follow-up time of two years was conducted. Patient demographics, complications, readmissions, and re-revision etiology and rates were compared between groups. Kaplan-Meier survivorship analysis was performed to estimate freedom from all-cause revision. Hospital LOS (3.41 ± 2.49 vs. 3.34 ± 1.93 days, p = 0.793) and discharge disposition (p = 0.418) did not significantly differ between groups. At a mean follow-up of 3.55 ± 1.60 years, the proportion of patients undergoing re-revision did not significantly differ (19.1% vs. 18.7%, p = 0.929). In subgroup analysis of re-revision causes, the VVC cohort had superior survival from re-revision due to instability compared to the PS cohort (97.8% vs. 89.4%, p = 0.003). Freedom from re-revision due to aseptic loosening did not significantly differ between groups (85.2% vs. 78.8%, p = 0.436). Improvements in range of motion (ROM) from preoperative to latest follow-up were similar as well. PS and VVC liners confer similar survivorship, complication rates, and overall knee ROM in rTKA. VVC liners were not associated with increased postoperative aseptic loosening and demonstrated superior freedom from re-revision due to instability. Future studies with longer follow-up are warranted to better determine significant differences in clinical outcomes between the two bearing options. Retrospective Cohort Study.
Identifiants
pubmed: 36178494
doi: 10.1007/s00402-022-04630-y
pii: 10.1007/s00402-022-04630-y
doi:
Substances chimiques
Polyethylene
9002-88-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
995-1004Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Ser A 89:780–785. https://doi.org/10.2106/JBJS.F.00222
doi: 10.2106/JBJS.F.00222
Malhotra R, Garg B, Kumar V (2011) Dual massive skeletal allograft in revision total knee arthroplasty. Indian J Orthop. https://doi.org/10.4103/0019-5413.82345
doi: 10.4103/0019-5413.82345
Hampton CB, Berliner ZP, Nguyen JT et al (2020) Aseptic loosening at the tibia in total knee arthroplasty: a function of cement mantle quality? J Arthroplasty 35:S190–S196. https://doi.org/10.1016/j.arth.2020.02.028
doi: 10.1016/j.arth.2020.02.028
Ponzio DY, Austin MS (2015) Metaphyseal bone loss in revision knee arthroplasty. Curr Rev Musculoskelet Med 8:361–367. https://doi.org/10.1007/s12178-015-9291-x
doi: 10.1007/s12178-015-9291-x
Khan M, Osman K, Green G, Haddad FS (2016) The epidemiology of failure in total knee arthroplasty. Bone Jt J 98-B:105–112. https://doi.org/10.1302/0301-620X.98B1.36293
doi: 10.1302/0301-620X.98B1.36293
Dorr LD, Boiardo RA (1986) Technical considerations in total knee arthroplasty. Clin Orthop Relat Res (205):5–11 . PMID: 3516503
Petrie JR, Haidukewych GJ (2016) Instability in total knee arthroplasty. Bone Jt J 98-B:116–119. https://doi.org/10.1302/0301-620X.98B1.36371
doi: 10.1302/0301-620X.98B1.36371
Dunbar MJ, Haddad FS (2014) Patient satisfaction after total knee replacement. Bone Jt J 96-B:1285–1286. https://doi.org/10.1302/0301-620X.96B10.34981
doi: 10.1302/0301-620X.96B10.34981
Dolan MM, Kelly NH, Nguyen JT et al (2011) Implant design influences tibial post wear damage in posterior-stabilized knees. Clin Orthop Relat Res 469:160–167. https://doi.org/10.1007/s11999-010-1515-1
doi: 10.1007/s11999-010-1515-1
Kahlenberg CA, Chalmers B, Sun HJ et al (2021) Polyethylene components in primary total knee arthroplasty: a comprehensive overview of fixed bearing design options. J Knee Surg. https://doi.org/10.1055/s-0041-1723981
doi: 10.1055/s-0041-1723981
Pagnano MW, Cushner FD, Scott NW (1998) Role of the posterior cruciate ligament in total knee arthroplasty. J Am Acad Orthop Surg 6:176–187. https://doi.org/10.5435/00124635-199805000-00006
doi: 10.5435/00124635-199805000-00006
Koh IJ, Chalmers CE, Lin CC et al (2021) Posterior stabilized total knee arthroplasty reproduces natural joint laxity compared to normal in kinematically aligned total knee arthroplasty: a matched pair cadaveric study. Arch Orthop Trauma Surg 141:119–127. https://doi.org/10.1007/s00402-020-03624-y
doi: 10.1007/s00402-020-03624-y
Sierra RJ, Berry DJ (2008) Surgical technique differences between posterior-substituting and cruciate-retaining total knee arthroplasty. J Arthroplasty 23:20–23. https://doi.org/10.1016/j.arth.2008.06.004
doi: 10.1016/j.arth.2008.06.004
Lei PF, Hu RY, Hu YH (2019) Bone defects in revision total knee arthroplasty and management. Orthop Surg 11:15–24. https://doi.org/10.1111/os.12425
doi: 10.1111/os.12425
Currier JH, Currier BH, Abdel MP et al (2021) What factors drive polyethylene wear in total knee arthroplasty? Bone Jt J 103-B:1695–1701. https://doi.org/10.1302/0301-620X.103B11.BJJ-2020-2334.R1
doi: 10.1302/0301-620X.103B11.BJJ-2020-2334.R1
Kim YH, Kim JS (2009) Revision total knee arthroplasty with use of a constrained condylar knee prosthesis. J Bone Jt Surg Ser A 91:1440–1447. https://doi.org/10.2106/JBJS.H.00425
doi: 10.2106/JBJS.H.00425
Colyn W, Neirynck J, Vanlommel E et al (2022) Primary constrained-condylar-knee designs outperform posterior-stabilized and cruciate-retaining designs in high-grade varus osteoarthritic knees during short-term follow-up: a pilot study. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04447-9
doi: 10.1007/s00402-022-04447-9
Konopka J, Weitzler L, Westrich D et al (2018) The effect of constraint on post damage in total knee arthroplasty: posterior stabilized vs posterior stabilized constrained inserts. Arthroplast Today 4:200–204. https://doi.org/10.1016/j.artd.2017.11.001
doi: 10.1016/j.artd.2017.11.001
Castagnini F, Bordini B, Cosentino M et al (2022) Constraint in complex primary total knee arthroplasty: rotating hinge versus condylar constrained implants. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-04322-z
doi: 10.1007/s00402-021-04322-z
Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-198911000-00003
doi: 10.1097/00003086-198911000-00003
Cameron HU, Hunter GA (1982) Failure in total knee arthroplasty: mechanisms, revisions, and results. Clin Orthop Relat Res (170):141–146. PMID: 7127939
Cholewinski P, Putman S, Vasseur L et al (2015) Long-term outcomes of primary constrained condylar knee arthroplasty. Orthop Traumatol Surg Res 101:449–454. https://doi.org/10.1016/j.otsr.2015.01.020
doi: 10.1016/j.otsr.2015.01.020
Luque R, Rizo B, Urda A et al (2014) Predictive factors for failure after total knee replacement revision. Int Orthop 38:429–435. https://doi.org/10.1007/s00264-013-2268-8
doi: 10.1007/s00264-013-2268-8
Gurel R, Morgan S, Elbaz E et al (2021) Good clinical and radiological outcomes of the varus-valgus constrained mobile-bearing implant in revision total knee arthroplasty. Int Orthop 45:1199–1204. https://doi.org/10.1007/s00264-021-05003-7
doi: 10.1007/s00264-021-05003-7
Moussa ME, Lee YY, Westrich GH et al (2017) Comparison of revision rates of non-modular constrained versus posterior stabilized total knee arthroplasty: a propensity score matched cohort study. HSS J 13:61–65. https://doi.org/10.1007/s11420-016-9533-5
doi: 10.1007/s11420-016-9533-5
Deshmukh AJ, Rathod PA, Moses MJ et al (2016) Does a non-stemmed constrained condylar prosthesis predispose to early failure of primary total knee arthroplasty? Knee Surg Sport Traumatol Arthrosc 24:3194–3199. https://doi.org/10.1007/s00167-014-3494-3
doi: 10.1007/s00167-014-3494-3
Kunze KN, Akram F, Fuller BC et al (2019) Superior survivorship for posterior stabilized versus constrained condylar articulations after revision total knee arthroplasty: a retrospective, comparative analysis at short-term follow-up. J Arthroplasty 34:3012-3017.e1. https://doi.org/10.1016/j.arth.2019.07.008
doi: 10.1016/j.arth.2019.07.008
Stockwell KD, Gascoyne TC, Singh M, Turgeon TR (2020) Survivorship of constrained polyethylene inserts in primary total knee replacements. Knee 27:1343–1348. https://doi.org/10.1016/j.knee.2020.06.010
doi: 10.1016/j.knee.2020.06.010
Fleischman AN, Azboy I, Restrepo C et al (2017) Optimizing mechanical alignment with modular stems in revision TKA. J Arthroplasty 32:S209–S213. https://doi.org/10.1016/j.arth.2017.05.039
doi: 10.1016/j.arth.2017.05.039
Kang SG, Park CH, Song SJ (2018) Stem fixation in revision total knee arthroplasty: indications, stem dimensions, and fixation methods. Knee Surg Relat Res 30:187–192. https://doi.org/10.5792/ksrr.18.019
doi: 10.5792/ksrr.18.019
Puah KL, Chong HC, Foo LSS et al (2018) Clinical and functional outcomes: primary constrained condylar knee arthroplasty compared with posterior stabilized knee arthroplasty. JAAOS Glob Res Rev 2:e084. https://doi.org/10.5435/jaaosglobal-d-17-00084
doi: 10.5435/jaaosglobal-d-17-00084
Hermans K, Vandenneucker H, Truijen J et al (2019) Hinged versus CCK revision arthroplasty for the stiff total knee. Knee 26:222–227. https://doi.org/10.1016/j.knee.2018.10.012
doi: 10.1016/j.knee.2018.10.012
King BR, Gladnick BP, Lee YY et al (2014) Range of motion and function are not affected by increased post constraint in patients undergoing posterior stabilized total knee arthroplasty. Knee 21:194–198. https://doi.org/10.1016/j.knee.2013.07.002
doi: 10.1016/j.knee.2013.07.002