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Constraint in complex primary total knee arthroplasty: rotating hinge versus condylar constrained implants

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

A Correction to this article was published on 17 August 2022

This article has been updated

Abstract

Introduction

Condylar constrained knee arthroplasties (CCKAs) and rotating hinge knee arthroplasties (RHKAs) achieved good outcomes in complex primary total knee arthroplasties (TKAs); however, long-term comparative studies are few. Using an arthroplasty registry, we sought to assess and compare in CCKAs and RHKAs: (1) the intra-operative rates of complications, (2) the survival rates, (3) the reasons for revision, and (4) the adjusted hazard ratios for failure.

Materials and methods

1432 constrained implants in primary TKAs performed for non-oncological indications were included: 703 RHKAs, 729 CCKAs. The two groups were comparable regarding age and gender. Kaplan–Meier curves were used to compare survival rates, multivariate analyses to assess the hazard ratios for failures.

Results

The mean follow-up was 4.1 years (range 0–16.3) for CCKAs and 6.8 years (0–18.1) for RHKAs. The intra/peri-operative complications were similar in both the cohorts, with similar rates of femoral and tibial fractures. 10-year implant survival rates were similar in both the cohorts (91.9%, CI 95% 89.2–93.9% in RHKAs; 93.4%, CI 95% 90.3–95.6% in CCKAs). Periprosthetic infection was the most common reason for revision in the two cohorts, followed by aseptic loosening. Breakage occurred in 3 RHKAs (0.4%). CCKAs and RHKAs had a similar distribution of revision causes. Males aged less than 60 had significantly more failures, regardless the constraint degree. Unstemmed CCKAs significantly failed more than RHKAs and stemmed CCKAs.

Conclusions

Both modern CCKAs and RHKAs are viable long-term solutions in complex primary TKAs. More failures should be expected in males aged less than 60.

Level of evidence

IV, Therapeutic study.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Francesco Castagnini, Stefano Lucchini, Giovanni Bracci & Francesco Traina

  2. Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy

    Barbara Bordini, Monica Cosentino & Cristina Ancarani

  3. DIBINEM University of Bologna, Bologna, Italy

    Francesco Castagnini

  4. Orthopaedics and Traumatology, DIBINEM University of Bologna, Bologna, Italy

    Francesco Traina

Authors
  1. Francesco Castagnini
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  2. Barbara Bordini
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  3. Monica Cosentino
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  4. Cristina Ancarani
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  5. Stefano Lucchini
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  6. Giovanni Bracci
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  7. Francesco Traina
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Contributions

FC concepted the design of the study, wrote the manuscript and corrected the final version. BB, MC and CA provided the data, analyzed the data and conducted the statistical analysis. SL and GB wrote the manuscript. FT designed the study, supervised the article production and corrected the final paper. All the Authors read and approved the final version.

Corresponding author

Correspondence to Francesco Castagnini.

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Conflict of interest

All the authors declare that they have no conflict of interest, as stated in the specific forms.

Ethical review committee statement

Institutional board review is not necessary for registry studies (data are collected as standard practice and the identity of the patients is concealed).

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No informed consents was collected as data are collected as a standard practice and the identity of the patients is concealed.

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Castagnini, F., Bordini, B., Cosentino, M. et al. Constraint in complex primary total knee arthroplasty: rotating hinge versus condylar constrained implants. Arch Orthop Trauma Surg 142, 3965–3973 (2022). https://doi.org/10.1007/s00402-021-04322-z

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  • DOI: https://doi.org/10.1007/s00402-021-04322-z

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