Revision total knee arthroplasty with the Total Condylar III system in inflammatory arthritis

Long-Term (Up to 21 Years) Survival of Revision Total Knee Arthroplasty with Use of a Constrained Condylar Knee Prosthesis: A Concise Follow-up of a Previous Report

In our original report, 97 patients (114 knees) underwent revision total knee arthroplasty with use of a Legacy Constrained Condylar Knee prosthesis (LCCK; Zimmer), with a mean follow-up of 7.2 years (range, 5 to 10 years). The purpose of the present study was to determine the long-term clinical and radiographic results, with a focus on component fixation and the prevalence of osteolysis. At a mean follow-up of 19.2 years (range, 16 to 21 years), re-revision of the LCCK prosthesis had been performed in 10 knees (9%). The rate of survival at 19.2 years was 96% (95% confidence interval [CI], 94% to 100%) with reoperation for mechanical failure as the end point, and 91% (95% CI, 87% to 98%) with reoperation for any reason as the end point. One knee had circumferential osteolysis around the components. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Radiographic Evaluations of Revision Total Knee Arthroplasty: A Plea for Uniform Assessments

Thorough radiographic evaluation is necessary for perioperative assessments in revision total knee arthroplasty. There has been a large degree of variability in reporting these findings within the peer-reviewed literature. Our purpose was to evaluate studies that radiographically assessed alignment in the coronal and sagittal plane, patella alignment and thickness, presence and characterization of implant interface, and radiolucency. Secondly, we reviewed studies using a standardized reporting system to evaluate radiographic findings (the Knee Society Roentgenographic Evaluation and Scoring System) and the number of times it was referenced. Only 62% of studies evaluated all radiographic parameters, 57% to 91% assessed each metric, and 55% used standardized reporting systems. This emphasizes the need for a uniform evaluation method to ensure consistent radiographic assessment and optimal standard of care.

Ten-Year Results of Primary and Revision Condylar-Constrained Total Knee Arthroplasty in Patients with Severe Coronal Plane Instability

Objective :

To retrospectively review the results at minimum ten years after surgery of a consecutive series of total knee arthroplasties (TKAs) performed using a constrained condylar implant in patients with severe coronal plane instability.

Materials and Methods :

The series comprised of 44 patients (45 knees) who received primary (19 knees) or revision (26 knees) TKA with a constrained condylar implant between 2001 and 2003 at a single institution.

Results :

There were no revisions or any other surgery related complications at a mean implantation time of 11.0 years. In 38 patients (15 knees in the primary group and 24 knees in the revision group) who were available for clinico-radiographic follow-up at a minimum of ten years, there was no sign of radiographic loosening. Two patients showed cortical hypertrophy at the extension stem tip but none complained of pain around the stem tip.

According to the TLKSS score grading, 73% of the patients in the primary group had results categorized as good or excellent, while 54% of the patients in the revision group had fair results. Four patients (one (7%) in the primary group and three (13%) in the revision group) had poor results. The median WOMAC Index was 80.2% (interquartile range: 74.0% - 81.2%) and 74.0% (interquartile range: 72.1% - 75.8%) in the primary and in the revision groups, respectively (p=0.010).

Conclusion :

This study showed satisfactory clinical outcomes with no re-operations at minimum ten years after implantation in patients who had undergone primary or revision TKA with a condylar constrained implant.

Revision TKA with a condylar constrained prosthesis using metaphyseal and surface cementation: a minimum 6-year follow-up analysis

Background

The increasing number of revision knee arthroplasty result in the more frequently use of a constraint implant but results from previous reports are difficult to interpret. The purpose of this study was to compare the long-term outcomes of superficial cemented versus metaphyseal cemented in revision total knee arthroplasty with a condylar constrained arthroplasty.

Methods

The study was a retrospective analysis of clinical and radiographic outcomes in a series of revision total knee arthroplasties performed with a constrained condylar knee prosthesis and press-fit modular stems. We hypothesized that the clinical and radiographic outcome of surface cementation would be inferior to that of metaphyseal cementation. Fifty-two consecutive revision cases were followed for a median of 8.2 years (range, 6 to 10 years).

Results

Substantial improvements in range of motion and Knee Society score were achieved in all patients, although these were not significant between groups. Significantly more radiolucent lines were visible on the tibial component with surface cementation than with metaphyseal cementation, although the clinical differences were not relevant.

Conclusions

Radiologic outcome was better in revision total knee arthroplasty using metaphyseal cemented revision and components with press-fit cementless stems than in the surface cementation–based approach; however, the difference was not clinically relevant.

2- to 9-year outcome of stemmed total knee arthroplasty. Similar failure rates in patients when used primary or as a revision

BACKGROUND AND PURPOSE

There is an increase in demand for primary and revision total knee joint procedures. We studied implant survival and functional outcome of patients operated with a constrained condylar knee (CCK) or a rotating hinge implant (RH) as a primary or a revision total knee arthoplasty (TKA).

PATIENTS AND METHODS

We evaluated clinically and radiographically 65 surgical procedures with a mean follow-up time of 5 (2-9) years (40 CCK and 25 RH). There were 24 primary TKAs-due to instability-and 41 revision TKAs, mostly due to aseptic loosening. Mean age at the index operation was 68 (31-88) years.

RESULTS

Overall, there were 12 failures, including 8 reoperations due to deep infection. The overall 5-year survival rate with reoperation as the endpoint was 82% (95% CI: 72-99). Radiolucent lines on either the femoral or the tibial side were seen in 36 cases. When comparing the cases that were operated as a primary TKA or as a revision TKA, function, health-related quality of life, and survival were similar. However, after primary TKA the patients generally had less pain and a higher proportion of patients were very satisfied or satisfied.

INTERPRETATION

Although a high rate of severe complications was observed, most patients improved in function after surgery regardless of whether it was a primary or a revision TKA. We found narrow radiolucent lines-mainly on the tibial side-in nearly half of the cases, but none of the implants were loose radiographically. Overall patient satisfaction and health-related quality of life were high, and a minority had problems with persistent pain.

Long-term survival of semi-constrained total knee arthroplasty for revision surgery

Semi-constrained implants provide stability in the setting of soft-tissue deficiency in revision total knee arthroplasty (TKA). This study evaluated our institution's long-term survival results with a semi-constrained implant used in the revision TKA setting. 234 semi-constrained revision total knee arthroplasties were performed in 209 patients. The average follow-up was 9 years. Forty repeat revisions were performed. 5-year survival was 91% and 10-year survival was 81%. Male gender significantly increased the risk of revision. At 10 years the average range of motion, pain level, and Knee Society score improved significantly (P < 0.001). Ninety percent of patients reported an improvement in their knee. The semi-constrained implant used in revision knee arthroplasty has acceptable implant survival and functional outcomes in the long-term follow-up period.

Revision total knee arthroplasty for aseptic and septic causes in patients with rheumatoid arthritis

Revision total knee arthroplasty in patients with rheumatoid arthritis can be challenging. We asked whether we could confirm previously reported high failure rates following revision total knee arthroplasty in patients with rheumatoid arthritis. We therefore determined the Knee Society knee score and function scores, radiographic evidence of failure, and overall survival of the revision procedure in these patients. We retrospectively reviewed 39 patients with rheumatoid arthritis who underwent 45 TKA revisions from 1994 to 2006. Twenty-seven of the 45 TKA revisions were for mechanical failure of the prosthetic components and 18 for infection. Five of the 27 knees (19%) revised for mechanical failure subsequently failed a second time. Five of the 18 patients who underwent revision for infection died within 6 months and three of the remaining knees failed secondary to reinfection. Excluding the knees that failed, the average Knee Society knee score and function score improved in both subgroups. Two knees had radiographic evidence of nonprogressive tibial radiolucencies. The probability of survival for all knees (revision as the end point) was 76% +/- 9% at 5 years. We confirmed the previously reported high mortality and subsequent failure rates following revision total knee arthroplasty for both mechanical issues and infection in patients with rheumatoid arthritis and emphasize the potential difficulties in treating these patients.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.