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Comparison of Revision Rates of Non-modular Constrained Versus Posterior Stabilized Total Knee Arthroplasty: a Propensity Score Matched Cohort Study

  • Original Article
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HSS Journal ®

Abstract

Background

Attaining stability during total knee arthroplasty (TKA) is essential for a successful outcome. Although traditional constrained total knee prostheses have generally been used in conjunction with intramedullary stems, some devices have been widely used without the use of stems, referred to as non-modular constrained condylar total knee arthroplasty (NMCCK).

Questions/Purposes

The aim of this study was to compare revisions rates after total knee replacement with a non-modular constrained condylar total knee (NMCCK) compared to a posterior-stabilized (PS) design.

Methods

Between 2007 and 2012, primary PS total knees were compared with NMCCK implants from the same manufacturer. Propensity score matching was performed, and implant survivorship was examined using a Cox proportional hazards model. The cohort consisted of 817 PS knees and 817 NMCCKs matched for patient demographics, surgeon volume, and pre-operative diagnosis.

Results

All cause revisions occurred in 11 of 817 (1.35%) in the PS group compared to 28 of 817 (3.43%) in the NMCCK group (p = 0.0168). Excluding revisions for infection and fracture, 8 of 817 (0.98%) PS knees required revision for mechanical failure compared to 18 of 817 (2.20%) NMCCK knees (p = 0.0193).

Conclusions

While revisions rates in both cohorts were low, there was a significantly higher revision rate with NMCCKs. Given that cases requiring the use of NMCCK implants are likely more complex than those in which PS implants are used, our findings support the judicious use of NMCCK prostheses.

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Acknowledgements

This study was funded through a grant (#1 U18 HS16075-01) from the Agency for Healthcare Research and Quality and The Centers for Education and Research on Therapeutics.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kaiser Permanente-Orange County, 3460 E La Palma Ave, Anaheim, CA, 92806, USA

    Mohamed E. Moussa MD

  2. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Mohamed E. Moussa MD, Yuo-yu Lee MS, Geoffrey H. Westrich MD, Nabil Mehta BSE, Stephen Lyman PhD & Robert G. Marx MD, MSc, FRCSC

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  1. Mohamed E. Moussa MD
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  2. Yuo-yu Lee MS
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  3. Geoffrey H. Westrich MD
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  4. Nabil Mehta BSE
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  5. Stephen Lyman PhD
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  6. Robert G. Marx MD, MSc, FRCSC
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Corresponding author

Correspondence to Mohamed E. Moussa MD.

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Conflict of Interest

Mohamed E. Moussa, MD, Yuo-yu Lee, MS, and Nabil Mehta, BSE have declared that they have no conflict of interest. Stephen Lyman, PhD reports grants from Agency for Healthcare Research and Quality, during the conduct of the study; personal fees from Journal of Bone & Joint Surgery, outside the work. Geoffrey H. Westrich, MD reports personal fees and non-financial support from Exactech, personal fees from Don Joy Orthopedics and Stryker Corporation, during the conduct of the study. Robert G. Marx, MD, MSc, FRCSC reports personal fees from Journal of Bone & Joint Surgery, Springer and Demos Health, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Retrospective cohort study, III.

Work performed at Hospital for Special Surgery.

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Moussa, M.E., Lee, Yy., Westrich, G.H. et al. Comparison of Revision Rates of Non-modular Constrained Versus Posterior Stabilized Total Knee Arthroplasty: a Propensity Score Matched Cohort Study. HSS Jrnl 13, 61–65 (2017). https://doi.org/10.1007/s11420-016-9533-5

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  • DOI: https://doi.org/10.1007/s11420-016-9533-5

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