Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis
Abstract Background Key to a successful outcome of total knee arthroplasty (TKA) is to attain optimum alignment, adequate balance, and deformity correction. In primary TKA, this can be achieved efficiently by posterior stabilized (PS) design with or without the sub-periosteal release. However, certa...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-018-0761-x |
| _version_ | 1828115480608505856 |
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| author | Saroj Rai Xianzhe Liu Xiaobo Feng Bimal Rai Nira Tamang Jing Wang Shunan Ye Shuhua Yang |
| author_facet | Saroj Rai Xianzhe Liu Xiaobo Feng Bimal Rai Nira Tamang Jing Wang Shunan Ye Shuhua Yang |
| author_sort | Saroj Rai |
| collection | DOAJ |
| description | Abstract Background Key to a successful outcome of total knee arthroplasty (TKA) is to attain optimum alignment, adequate balance, and deformity correction. In primary TKA, this can be achieved efficiently by posterior stabilized (PS) design with or without the sub-periosteal release. However, certain circumstances such as post-traumatic arthritis are often associated with severe deformities with a significant bone defect, stiffness, and instability. Such deformities are extremely difficult to balance with soft tissue release only and require additionally constrained prostheses even in primary TKA. In such situation, constrained condylar knee (CCK) design is the ultimate choice. This study primarily aimed to report on clinical outcome, regain of function, and complication of patients who underwent primary CCK-TKA for severe deformity of the knee secondary to post-traumatic arthritis. The secondary aim was to find out the mid-term prostheses survival. Methods Between February 2007 and November 2013, 38 consecutive patients with post-traumatic arthritis of the knee received cemented primary CCK-TKA. Thirty-four patients (21 men and 13 women) who had a minimum of 3 years follow-up were included in this retrospective study. We used Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, and roentgenographic evaluation form to assess the patients. Prostheses survival was assessed using Kaplan-Meier’s survival analysis. Results Patients were followed up for an average duration of 6.47 years. KSS knee score improved from 44 points (23–68) pre-operatively to 91 points (76–100) post-operatively [P < 0.001]. The average KSS functional score improved from 49 points (20–75) pre-operatively to 91 points (65–100) post-operatively [P < 0.001]. The average HSS score improved from 51 points (27–83) pre-operatively to 91 points (75–100) post-operatively [P < 0.001]. Similarly, the average ROM improved from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) post-operatively [P < 0.001]. The average hip-knee-ankle (HKA) angle was 176.88° ± 14.48° (135°–199°) pre-operatively and 180.24° ± 1.77° (175°–184°) post-operatively. Radiolucencies were evident in 13 knees, mostly on the tibial side. Prostheses survival was 94.7% at a mean follow-up of 6.47 years. Conclusion Despite severe deformity, instability, and stiffness at a relatively young age, mid-term follow-up of primary CCK-TKA in post-traumatic arthritis provides satisfactory clinical and functional outcomes with 94.7% prostheses survival. However, it is not without complication. |
| first_indexed | 2024-04-11T12:40:59Z |
| format | Article |
| id | doaj.art-7e24a1b2c5f54a0ebf37ebd869c7474a |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T12:40:59Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-7e24a1b2c5f54a0ebf37ebd869c7474a2022-12-22T04:23:30ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2018-04-011311910.1186/s13018-018-0761-xPrimary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritisSaroj Rai0Xianzhe Liu1Xiaobo Feng2Bimal Rai3Nira Tamang4Jing Wang5Shunan Ye6Shuhua Yang7Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologySchool of Nursing, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background Key to a successful outcome of total knee arthroplasty (TKA) is to attain optimum alignment, adequate balance, and deformity correction. In primary TKA, this can be achieved efficiently by posterior stabilized (PS) design with or without the sub-periosteal release. However, certain circumstances such as post-traumatic arthritis are often associated with severe deformities with a significant bone defect, stiffness, and instability. Such deformities are extremely difficult to balance with soft tissue release only and require additionally constrained prostheses even in primary TKA. In such situation, constrained condylar knee (CCK) design is the ultimate choice. This study primarily aimed to report on clinical outcome, regain of function, and complication of patients who underwent primary CCK-TKA for severe deformity of the knee secondary to post-traumatic arthritis. The secondary aim was to find out the mid-term prostheses survival. Methods Between February 2007 and November 2013, 38 consecutive patients with post-traumatic arthritis of the knee received cemented primary CCK-TKA. Thirty-four patients (21 men and 13 women) who had a minimum of 3 years follow-up were included in this retrospective study. We used Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, and roentgenographic evaluation form to assess the patients. Prostheses survival was assessed using Kaplan-Meier’s survival analysis. Results Patients were followed up for an average duration of 6.47 years. KSS knee score improved from 44 points (23–68) pre-operatively to 91 points (76–100) post-operatively [P < 0.001]. The average KSS functional score improved from 49 points (20–75) pre-operatively to 91 points (65–100) post-operatively [P < 0.001]. The average HSS score improved from 51 points (27–83) pre-operatively to 91 points (75–100) post-operatively [P < 0.001]. Similarly, the average ROM improved from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) post-operatively [P < 0.001]. The average hip-knee-ankle (HKA) angle was 176.88° ± 14.48° (135°–199°) pre-operatively and 180.24° ± 1.77° (175°–184°) post-operatively. Radiolucencies were evident in 13 knees, mostly on the tibial side. Prostheses survival was 94.7% at a mean follow-up of 6.47 years. Conclusion Despite severe deformity, instability, and stiffness at a relatively young age, mid-term follow-up of primary CCK-TKA in post-traumatic arthritis provides satisfactory clinical and functional outcomes with 94.7% prostheses survival. However, it is not without complication.http://link.springer.com/article/10.1186/s13018-018-0761-xTotal knee arthroplastyConstrained condylar kneeKnee Society ScorePost-traumatic arthritis |
| spellingShingle | Saroj Rai Xianzhe Liu Xiaobo Feng Bimal Rai Nira Tamang Jing Wang Shunan Ye Shuhua Yang Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis Journal of Orthopaedic Surgery and Research Total knee arthroplasty Constrained condylar knee Knee Society Score Post-traumatic arthritis |
| title | Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis |
| title_full | Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis |
| title_fullStr | Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis |
| title_full_unstemmed | Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis |
| title_short | Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis |
| title_sort | primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post traumatic arthritis |
| topic | Total knee arthroplasty Constrained condylar knee Knee Society Score Post-traumatic arthritis |
| url | http://link.springer.com/article/10.1186/s13018-018-0761-x |
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