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Primary TKA in patients with major deformities and ligament laxities: promising results of an intermediate constrained implant at mid-term follow-up

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Total knee arthroplasty (TKA) in major deformities with ligament insufficiency may require a higher constraint, with bone sacrifice and concerns about long-term survivorship. Mid-level constraint liners have been recently introduced, but few studies described their outcomes. The aim of this study is to evaluate the short to mid-term outcomes of a constrained postero-stabilized (CPS) insert for primary TKA in moderate to severe deformities.

Methods

All patients who underwent TKA using a CPS liner in two centers between 2015 and 2017 were included in the study. The indications were: (1) valgus deformity type 2–3 partially correctable; (2) severe varus deformity with varus thrust; (3) post-traumatic deformity with major ligamentous insufficiency and any case of intra-operative ligament insufficiency. Patients were evaluated according to the Knee Society Scoring System (KSS), the Hospital for Special Surgery score (HSS), the Western Ontario and Mc Master University (WOMAC) and the Oxford Knee score (OKS). X-rays were evaluated according to the Knee Society Roentgenographic Evaluation System.

Results

Forty-seven TKA were included, with an average age of 66.1 ± 10.3 years and an average follow-up of 68.4 ± 6 months. All patients demonstrated a moderate to severe pre-operative mediolateral instability. All the scores significantly improved (p < 0.0001). In 71.4% of cases, the outcomes were excellent or very good. There were no failures due to aseptic loosening but one failure due to a traumatic ligament rupture. The cumulative survivorship was 97.9% ± 2.1% at 84 months.

Conclusions

This mid-range constraint total knee replacement demonstrated promising outcomes and survival at mid-term follow-up.

Level of evidence

IV (case series).

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Authors and Affiliations

  1. Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy

    Federica Rosso, Roberto Rossi & Davide Edoardo Bonasia

  2. Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Via Po 8, 10100, Turin, Italy

    Roberto Rossi

  3. Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy

    Francesco Benazzo & Stefano Marco Paolo Rossi

  4. Clinica Ortopedica e Traumatologia, Università degli Studi di Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Matteo Ghiara

  5. IUSS, Istituto Universitario di Studi Superiori, Pavia, Italy

    Francesco Benazzo

Authors
  1. Federica Rosso
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  2. Roberto Rossi
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  3. Francesco Benazzo
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  4. Matteo Ghiara
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  5. Davide Edoardo Bonasia
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  6. Stefano Marco Paolo Rossi
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Contributions

SMPR and FR  designed the study. FB, RR and SMPR performed the surgeries. MG, FR and DLB collected the data. FR drafted the manuscript. SMPR critically revised it. FB and RR gave final approval before submission. This manuscript is original and not published elsewhere.

Corresponding author

Correspondence to Stefano Marco Paolo Rossi.

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Conflict of interest

R. Rossi is a teaching consultant for Arthrex, Zimmer-Biomet, Lima, Medacta, Smith and Nephew, De Puy. F. Benazzo is a teaching consultant for Zimmer Biomet, Limacorporate and Ceramtec. D.E. Bonasia is a teaching consultant for Arthrex and Zimmer-Biomet; (2) Editorial royalties for Elsevier and Springer; (3) Editorial board “The Knee” Journal, Elsevier. The other authors certify that they have no commercial associations that might pose a conflict of interest in connection with the submitted article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: for this type of study formal consent is not required. All patients signed an informed consent for the surgical procedure.

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Rosso, F., Rossi, R., Benazzo, F. et al. Primary TKA in patients with major deformities and ligament laxities: promising results of an intermediate constrained implant at mid-term follow-up. Arch Orthop Trauma Surg 143, 2675–2681 (2023). https://doi.org/10.1007/s00402-022-04527-w

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