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J Knee Surg 2020; 33(07): 678-684
DOI: 10.1055/s-0039-1683976
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

Fahad Hossain
1   University College London Hospitals NHS Foundation Trust, London, United Kingdom
2   Walsall Healthcare Trust, Walsall, United Kingdom
,
Sujith Konan
1   University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Babar Kayani
1   University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Christina Kontoghiorghe
1   University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Toby Barrack
1   University College London Hospitals NHS Foundation Trust, London, United Kingdom
3   Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
,
Fares Sami Haddad
1   University College London Hospitals NHS Foundation Trust, London, United Kingdom
› Author Affiliations
Further Information

Publication History

14 November 2018

18 February 2019

Publication Date:
08 April 2019 (online)

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Abstract

The use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

Keywords

totally stabilized knee - valgus–varus constrained knee - complex primary TKA - functional outcomes

Ethical Approval

This study was performed with the approval of the institutional clinical governance committee and in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required


 

  • References

  • 1 Meloni MC, Hoedemaeker RW, Violante B, Mazzola C. Soft tissue balancing in total knee arthroplasty. Joints 2014; 2 (01) 37-40
    PubMedSearch in Google Scholar
  • 2 Bargiotas KA. Long term outcome of total knee arthroplasty. Condylar constrained prostheses. In: Karachalios T. , ed. Total Knee Arthroplasty: Long Term Outcomes. London: Springer; 2015: 169-77
    Search in Google Scholar
  • 3 Whiteside LA. Soft tissue balancing: the knee. J Arthroplasty 2002; 17 (04) (Suppl. 01) 23-27
    CrossrefPubMedSearch in Google Scholar
  • 4 Anderson JA, Baldini A, MacDonald JH, Tomek I, Pellicci PM, Sculco TP. Constrained condylar knee without stem extensions for difficult primary total knee arthroplasty. J Knee Surg 2007; 20 (03) 195-198
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 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
    PubMedSearch in Google Scholar
  • 6 Rawlinson JJ, Closkey Jr RF, Davis N, Wright TM, Windsor R. Stemmed implants improve stability in augmented constrained condylar knees. Clin Orthop Relat Res 2008; 466 (11) 2639-2643
    CrossrefPubMedSearch in Google Scholar
  • 7 Yoshii I, Whiteside LA, Milliano MT, White SE. The effect of central stem and stem length on micromovement of the tibial tray. J Arthroplasty 1992; 7 (Suppl): 433-438
    CrossrefPubMedSearch in Google Scholar
  • 8 Barrack RL, Rorabeck C, Burt M, Sawhney J. Pain at the end of the stem after revision total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 216-225
    PubMedSearch in Google Scholar
  • 9 Completo A, Fonseca F, Simões JA. Strain shielding in proximal tibia of stemmed knee prosthesis: experimental study. J Biomech 2008; 41 (03) 560-566
    CrossrefPubMedSearch in Google Scholar
  • 10 Glenn JC, Sokoloski SN, Damer BM, Tabit JM. Tibia pain at end of stem with stemmed revision total knee arthroplasty: treatment with cortical strut graft technique. J Arthroplasty 2010; 25 (03) 497.e1-497.e5
    PubMedSearch in Google Scholar
  • 11 Soranoglou V, Poultsides LA, De Martino I, Apolito RD, Sculco PK, Sculco TP. Stemless constrained total knee arthroplasty: an obsolete concept or a contemporary solution?. Semin Arthroplasty 2015; 26 (04) 236-241
    CrossrefPubMedSearch in Google Scholar
  • 12 Morgan-Jones R, Oussedik SI, Graichen H, Haddad FS. Zonal fixation in revision total knee arthroplasty. Bone Joint J 2015; 97-B: (02) 147-149
    PubMedSearch in Google Scholar
  • 13 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
    CrossrefPubMedSearch in Google Scholar
  • 14 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
    CrossrefPubMedSearch in Google Scholar
  • 15 Nazarian DG, Mehta S, Booth Jr RE. A comparison of stemmed and unstemmed components in revision knee arthroplasty. Clin Orthop Relat Res 2002; (404) 256-262
    PubMedSearch in Google Scholar
  • 16 Kim HY, Kim KJ, Yang DS, Jeung SW, Choi HG, Choy WS. Screw-home movement of the tibiofemoral joint during normal gait: three-dimensional analysis. Clin Orthop Surg 2015; 7 (03) 303-309
    CrossrefPubMedSearch in Google Scholar
  • 17 Freeman MA, Pinskerova V. The movement of the normal tibio-femoral joint. J Biomech 2005; 38 (02) 197-208
    CrossrefPubMedSearch in Google Scholar
  • 18 Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB. , et al. Cost-effectiveness of total knee replacement: a prospective cohort study. Arthritis Care Res (Hoboken) 2014; 66 (04) 592-599
    PubMedSearch in Google Scholar
  • 19 Jenkins PJ, Clement ND, Hamilton DF, Gaston P, Patton JT, Howie CR. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone Joint J 2013; 95-B (01) 115-121
    CrossrefPubMedSearch in Google Scholar
  • 20 Hossain F, Patel S, Haddad FS. Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (05) 1221-1228
    CrossrefPubMedSearch in Google Scholar
  • 21 Legion Total Knee System. Total System Specification Guide and Product Catalog. Smith And Nephew, 2015 . Available at: https://www.smith-nephew.com/global/assets/pdf/products/surgical/legion_tks_primary_through_hinge_specifications_guide_02861v1.pdf . Accessed March 8, 2019
    PubMed
  • 22 NexGen® Legacy® Constrained Condylar Knee (LCCK). Available at: http://www.zimmer.co.uk/medical-professionals/products/knee/nexgen-lcck.html . Accessed March 8, 2019
    PubMed
  • 23 OPTETRAK LOGIC Design Rationale. Available at: https://content.exac.com/wp-content/uploads/sites/3/2016/10/712-25-40_RevA_Logic_DR-1.pdf . Accessed March 20, 2019
    PubMed
  • 24 Kader D, Caplan N, Kokkinakis M, Refaie R, Loughead J. Constrained condylar knee systems: a review of five commonly used brands. J Arthrosc Jt Surg 2015; 2: 23-32
    PubMedSearch in Google Scholar
  • 25 Stryker Orthopaedics Triathlon TS Knee System Product Catalog. Mahwah, NJ: Stryker; 2007: 124
    Search in Google Scholar
  • 26 Bottros J, Gad B, Krebs V, Barsoum WK. Gap balancing in total knee arthroplasty. J Arthroplasty 2006; 21 (04) (Suppl. 01) 11-15
    CrossrefPubMedSearch in Google Scholar
  • 27 Sikorski JM. Alignment in total knee replacement. J Bone Joint Surg Br 2008; 90 (09) 1121-1127
    CrossrefPubMedSearch in Google Scholar
  • 28 Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am 2009; 91 (01) 38-47
    PubMedSearch in Google Scholar
  • 29 Cipriano CA, Brown NM, Della Valle CJ, Moric M, Sporer SM. Intra-operative periprosthetic fractures associated with press fit stems in revision total knee arthroplasty: incidence, management, and outcomes. J Arthroplasty 2013; 28 (08) 1310-1313
    CrossrefPubMedSearch in Google Scholar
  • 30 Hossain F, Patel S, Rhee SJ, Haddad FS. Knee arthroplasty with a medially conforming ball-and-socket tibiofemoral articulation provides better function. Clin Orthop Relat Res 2011; 469 (01) 55-63
    CrossrefPubMedSearch in Google Scholar
  • 31 King BR, Gladnick BP, Lee YY, Lyman S, Della Valle AG. Range of motion and function are not affected by increased post constraint in patients undergoing posterior stabilized total knee arthroplasty. Knee 2014; 21 (01) 194-198
    CrossrefPubMedSearch in Google Scholar
  • 32 Liddle AD, Pandit H, Judge A, Murray DW. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Joint J 2015; 97-B (06) 793-801
    CrossrefPubMedSearch in Google Scholar
  • 33 Nerhus TK, Heir S, Thornes E, Madsen JE, Ekeland A. Time-dependent improvement in functional outcome following LCS rotating platform knee replacement. Acta Orthop 2010; 81 (06) 727-732
    CrossrefPubMedSearch in Google Scholar
  • 34 Nilsdotter AK, Toksvig-Larsen S, Roos EM. A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthritis Cartilage 2009; 17 (05) 601-606
    CrossrefPubMedSearch in Google Scholar
  • 35 Deshmukh AJ, Rathod PA, Moses MJ, Snir N, Marwin SE, Dayan AJ. Does a non-stemmed constrained condylar prosthesis predispose to early failure of primary total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3194-3199
    CrossrefPubMedSearch in Google Scholar
  • 36 Ghosh KM, Manning WA, Blain AP. , et al. Influence of increasing construct constraint in the presence of posterolateral deficiency at knee replacement: a biomechanical study. J Orthop Res 2016; 34 (03) 427-434
    CrossrefPubMedSearch in Google Scholar
  • 37 Martin JR, Fehring KA, Watts CD, Levy DL, Springer BD, Kim RH. Coronal alignment predicts the use of semi-constrained implants in contemporary total knee arthroplasty. Knee 2017; 24 (04) 863-868
    CrossrefPubMedSearch in Google Scholar
  • 38 Schiraldi M, Bonzanini G, Chirillo D, de Tullio V. Mechanical and kinematic alignment in total knee arthroplasty. Ann Transl Med 2016; 4 (07) 130
    CrossrefPubMedSearch in Google Scholar
  • 39 Hadi M, Barlow T, Ahmed I, Dunbar M, McCulloch P, Griffin D. Does malalignment affect revision rate in total knee replacements: a systematic review of the literature. Springerplus 2015; 4: 835
    CrossrefPubMedSearch in Google Scholar
  • 40 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
    CrossrefPubMedSearch in Google Scholar
  • 41 Moussa ME, Lee YY, Westrich GH, Mehta N, Lyman S, Marx RG. Comparison of revision rates of non-modular constrained versus posterior stabilized total knee arthroplasty: a propensity score matched cohort study. HSS J 2017; 13 (01) 61-65
    CrossrefPubMedSearch in Google Scholar
  • 42 Ruel A, Ortiz P, Westrich G. Five year survivorship of primary non-modular stemless constrained knee arthroplasty. Knee 2016; 23 (04) 716-718
    CrossrefPubMedSearch in Google Scholar
  • 43 Padgett DE, Cottrell J, Kelly N, Gelber J, Farrell C, Wright TM. Retrieval analysis of nonmodular constrained tibial inserts after primary total knee replacement. Orthop Clin North Am 2012; 43 (05) e39-e43
    CrossrefPubMedSearch in Google Scholar
  • 44 Kim SH, Park YB, Song MK, Lim JW, Lee HJ. Reliability and validity of the femorotibial mechanical axis angle in primary total knee arthroplasty: navigation versus weight bearing or supine whole leg radiographs. Knee Surg Relat Res 2018; 30 (04) 326-333
    CrossrefPubMedSearch in Google Scholar