HSS Journal ®

, Volume 13, Issue 1, pp 61–65 | Cite as

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

  • Mohamed E. Moussa
  • Yuo-yu Lee
  • Geoffrey H. Westrich
  • Nabil Mehta
  • Stephen Lyman
  • Robert G. Marx
Original Article



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).


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.


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.


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).


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.


total knee arthroplasty revision total knee arthroplasty constrained total knee arthroplasty posterior stabilized total knee arthroplasty 

Supplementary material

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  1. 1.
    Anderson JA, Baldini A, MacDonald JH, Pellicci PM, Sculco TP. Primary constrained condylar knee arthroplasty without stem extensions for the valgus knee. Clin Orthop Relat Res. 2006; 442: 199-203.CrossRefPubMedGoogle Scholar
  2. 2.
    Anderson JA, Baldini A, MacDonald JH, Tomek I, Pellicci PM, Sculco TP. Constrained condylar knee without stem extensions for difficult primary total knee arthroplasty. J Knee Surg. 2007; 20(3): 195-8.PubMedGoogle Scholar
  3. 3.
    Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011; 46(3): 399-424.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Buechel FF. A sequential three-step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty. Clin Orthop Relat Res. 1990; 260: 170-5.Google Scholar
  5. 5.
    Easley ME, Insall JN, Scuderi GR, Bullek DD. Primary constrained condylar knee arthroplasty for the arthritic valgus knee. Clin Orthop Relat Res. 2000; 380: 58-64.CrossRefGoogle Scholar
  6. 6.
    Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg Am. 2004; 86-A(12): 2671-6.CrossRefPubMedGoogle Scholar
  7. 7.
    Krackow KA, Jones MM, Teeny SM, Hungerford DS. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res. 1991; 273: 9-18.Google Scholar
  8. 8.
    Lachiewicz PF, Soileau ES. Ten-year survival and clinical results of constrained components in primary total knee arthroplasty. J Arthroplasty. 2006; 21(6): 803-8.CrossRefPubMedGoogle Scholar
  9. 9.
    Lachiewicz PF, Soileau ES. Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty. J Arthroplasty. 2011; 26(8): 1228-31.CrossRefPubMedGoogle Scholar
  10. 10.
    Maynard LM, Sauber TJ, Kostopoulos VK, Lavigne GS, Sewecke JJ, Sotereanos NG. Survival of primary condylar-constrained total knee arthroplasty at a minimum of 7 years. J Arthroplasty. 2014; 29(6): 1197-201.CrossRefPubMedGoogle Scholar
  11. 11.
    Nam D, Umunna B-PN, Cross MB, Reinhardt KR, Duggal S, Cornell CN. Clinical results and failure mechanisms of a nonmodular constrained knee without stem extensions. HSS J. 2012; 8(2): 96-102.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Padgett DE, Cottrell J, Kelly N, Gelber J, Farrell C, Wright TM. Retrieval analysis of nonmodular constrained tibial inserts after primary total knee replacement. Orthop Clin North Am. 2012; 43(5): e39-43.CrossRefPubMedGoogle Scholar
  13. 13.
    Rosenbaum P, Rubin D. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat. 1985; 39(1): 33-38.Google Scholar
  14. 14.
    Sculco TP. The role of constraint in total knee arthoplasty. J Arthroplasty. 2006; 21(4 Suppl 1): 54-6.CrossRefPubMedGoogle Scholar
  15. 15.
    Stern SH, Wills RD, Gilbert JL. The effect of tibial stem design on component micromotion in knee arthroplasty. Clin Orthop Relat Res. 1997; 345: 44-52.CrossRefGoogle Scholar
  16. 16.
    Whiteside LA. Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop Relat Res. 1993; 288: 234-45.Google Scholar
  17. 17.
    Yoshii I, Whiteside LA, Milliano MT, White SE. The effect of central stem and stem length on micromovement of the tibial tray. J Arthroplasty. 1992; 7(Suppl): 433-8.CrossRefPubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2016

Authors and Affiliations

  • Mohamed E. Moussa
    • 1
    • 2
  • Yuo-yu Lee
    • 2
  • Geoffrey H. Westrich
    • 2
  • Nabil Mehta
    • 2
  • Stephen Lyman
    • 2
  • Robert G. Marx
    • 2
  1. 1.Department of Orthopaedic SurgeryKaiser Permanente-Orange CountyAnaheimUSA
  2. 2.Hospital for Special SurgeryNew YorkUSA

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