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Shichman I, Oakley CT, Beaton G, Anil U, Snir N, Rozell J, Meftah M, Schwarzkopf R. The impact of posterior-stabilized vs. constrained polyethylene liners in revision total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:995-1004. [PMID: 36178494 DOI: 10.1007/s00402-022-04630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/18/2022] [Indexed: 11/02/2022]
Abstract
AIM 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Ittai Shichman
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.,Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Christian T Oakley
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Geidily Beaton
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Utkarsh Anil
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Nimrod Snir
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joshua Rozell
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Morteza Meftah
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
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Stockwell KD, Gascoyne TC, Singh M, Turgeon TR. Survivorship of constrained polyethylene inserts in primary total knee replacements. Knee 2020; 27:1343-1348. [PMID: 33010746 DOI: 10.1016/j.knee.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/13/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Varus-valgus constrained (VVC) inserts are used in primary total knee arthroplasty (TKA) when stability cannot be achieved with a traditional insert. Concern has been raised regarding premature loosening and failure of these primary TKAs due to the increased load transfer through the prosthesis. This study seeks to assess the survival, clinical outcomes and radiographic assessment of VVC total knee inserts used in a single primary TKA system without diaphyseal stem extensions. METHODS A consecutive cohort of 74 primary TKAs with VVC inserts was identified from an institutional database. A two-to-one matched group of 136 posterior-stabilized (PS) primary TKAs was generated from the same database. Survival analysis was assessed for all-cause revision surgery. Patient outcome measures were the Oxford Knee Score (OKS) and patient reported satisfaction. Radiographs were assessed in accordance with the Knee Society radiographic scoring system for radiolucency. RESULTS Survival rates at three and five years were 98.1% and 95.1% for the VVC liner group and 98.1% and 98.1% for the PS liner group, respectively. OKS improved from pre-op to post-op for both groups (p < .001). OKS was reduced in the VVC liner group compared to the PS liner group at latest available follow-up (p = .012). However, clinical satisfaction rates did not differ between the two groups. Small, non-progressive radiolucent lines existed on several radiographs; however, no components in either group were deemed radiographically loose. CONCLUSION The survivorship, clinical, and radiographic outcomes of VVC knees were similar to the PS comparison group at short- to mid-term follow-up.
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Affiliation(s)
- Kevin D Stockwell
- Department of Surgery, Section of Orthopaedics, University of Manitoba, Winnipeg, Manitoba, Canada; Orthopaedic Innovation Centre, Concordia Hip & Knee Institute, Winnipeg, Manitoba, Canada
| | - Trevor C Gascoyne
- Orthopaedic Innovation Centre, Concordia Hip & Knee Institute, Winnipeg, Manitoba, Canada
| | - Mandip Singh
- Department of Surgery, Section of Orthopaedics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas R Turgeon
- Department of Surgery, Section of Orthopaedics, University of Manitoba, Winnipeg, Manitoba, Canada; Concordia Joint Replacement Group, Concordia Hip & Knee Institute, Winnipeg, Manitoba, Canada.
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