Primary Constrained Condylar Knee Arthroplasty in Severe Varus Deformity: a Prospective 5-year Functional Follow-up Study in Iraqi Patients

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2023 Jan 2

PMID 36592240

Authors

Ahmed Alqatub

Ghazwan A Hasan

Mahmood Shihab Wahab

Mustafa Hayder Katran

Yasameen Bani Wais

Abbas F Masaoodi

Gautam M Shetty

Affiliations

Soon will be listed here.

Abstract

Purpose: The outcomes of the constrained condylar knee (CCK) implant used during primary total knee arthroplasty (TKA) in knees with severe varus in patients from low- and middle-income countries (LMICs) such as Iraq are not known. Hence, this study aimed to analyze and report the functional outcome of CCK TKA in patients with severe varus deformities at the end of 5 years in Iraqi patients.

Methods: In this prospective study, pre- and post-operative (at the end of 5 years) clinical outcome using Knee Society Score (KSS) and radiological deformity using hip-knee-ankle (HKA) angle was analyzed in 76 CCK TKAs (20 bilateral and 36 unilateral TKAs) performed in 56 patients with severe varus deformity (> 15°).

Results: At a mean follow-up of 60.3 months (range 60-68 months), the mean preoperative KSS knee score of 6.6 ± 4.5 improved significantly (p < 0.0001) to 87.2 ± 6.6 and the mean preoperative KSS function score of 7.1 ± 6.4 improved significantly (p < 0.0001) to 70.4 ± 7.8. The function score was good to excellent in 64.3% (36 patients), fair in 28.5% (16 patients), and poor in 7.1% (4 patients) at the end of 5 years. The mean preoperative HKA angle significantly improved (p < 0.001) from 25.5° ± 6° varus (range 17°-37°) to 3° ± 2.5° varus (range 0°-7.5°) at final follow-up.

Conclusion: The CCK implant significantly improved pain and function in patients with severe varus deformity at the end of 5 years. The CCK implant is a good option during primary TKA in severe varus knees in patients from LMICs and can help achieve clinical outcomes similar to patients from high-income countries.

References

Naudie D, Rorabeck C . Managing instability in total knee arthroplasty with constrained and linked implants. Instr Course Lect. 2004; 53:207-15. View

Martin J, Beahrs T, Stuhlman C, Trousdale R . Complex Primary Total Knee Arthroplasty: Long-Term Outcomes. J Bone Joint Surg Am. 2016; 98(17):1459-70. DOI: 10.2106/JBJS.15.01173. View

Feng X, Yang C, Fu D, Ye S, Liu X, Chen Z . Mid-term outcomes of primary constrained condylar knee arthroplasty for severe knee deformity. J Huazhong Univ Sci Technolog Med Sci. 2016; 36(2):231-236. DOI: 10.1007/s11596-016-1572-0. View

Rai S, Liu X, Feng X, Rai B, Tamang N, Wang J . Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis. J Orthop Surg Res. 2018; 13(1):67. PMC: 5879997. DOI: 10.1186/s13018-018-0761-x. View

Fujiwara T, Fujimura K, Hamai S, Kamura S, Nakashima Y, Miyahara H . Mid-term clinical outcome of constrained condylar knee prosthesis for patients with rheumatoid arthritis. Mod Rheumatol. 2018; 29(4):596-601. DOI: 10.1080/14397595.2018.1486954. View

Mancino F, Martino I, Burrofato A, De Ieso C, Saccomanno M, Maccauro G . Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up. J Orthop Traumatol. 2020; 21(1):22. PMC: 7710834. DOI: 10.1186/s10195-020-00561-9. View

Lachiewicz P, Soileau E . Ten-year survival and clinical results of constrained components in primary total knee arthroplasty. J Arthroplasty. 2006; 21(6):803-8. DOI: 10.1016/j.arth.2005.09.008. View

Castagnini F, Bordini B, Cosentino M, Ancarani C, Lucchini S, Bracci G . Constraint in complex primary total knee arthroplasty: rotating hinge versus condylar constrained implants. Arch Orthop Trauma Surg. 2022; 142(12):3965-3973. DOI: 10.1007/s00402-021-04322-z. View

Lim J, Pang H, Tay K, Chia S, Lo N, Yeo S . Increased constraint of rotating hinge knee prosthesis is associated with poorer clinical outcomes as compared to constrained condylar knee prosthesis in total knee arthroplasty. Eur J Orthop Surg Traumatol. 2019; 30(3):529-535. DOI: 10.1007/s00590-019-02598-x. View

10.

Badawy M, Fenstad A, Furnes O . Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994-2017. Acta Orthop. 2019; 90(5):467-472. PMC: 6746286. DOI: 10.1080/17453674.2019.1627638. View

11.

Pedneault C, St George S, Masri B . Challenges to Implementing Total Joint Replacement Programs in Developing Countries. Orthop Clin North Am. 2020; 51(2):131-139. DOI: 10.1016/j.ocl.2019.11.001. View

12.

King B, Gladnick B, Lee Y, Lyman S, Gonzalez Della Valle A . Range of motion and function are not affected by increased post constraint in patients undergoing posterior stabilized total knee arthroplasty. Knee. 2013; 21(1):194-8. DOI: 10.1016/j.knee.2013.07.002. View