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Primary constrained-condylar-knee designs outperform posterior-stabilized and cruciate-retaining designs in high-grade varus osteoarthritic knees during short-term follow-up: a pilot study

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

Abstract

Introduction

High-grade varus osteoarthrosis (OA) is characterized by a pronounced intra-articular varus deformity and associated insufficiency of the lateral ligamentous complex. When performing a total knee arthroplasty (TKA) in such a knee, traditionally the alignment is restored to neutral, and the medial soft tissue structures are released to compensate for the lateral laxity and balance the joint. However, another option would be to leave the medial soft tissues untouched and accept the lateral laxity but to compensate for it using an ML-stabilized constrained-condylar knee (CCK) design. Our aim was to prove our hypothesis that such knees would demonstrate better clinical stability and better functionality as well as subjective outcome scores.

Materials and methods

We searched our bicenter database of 912 primary TKAs (from 2016 to 2019) for primary TKA patients with a preoperative varus alignment of > 8°. After inclusion, 60 patients were divided into three groups by implant design: CCK (n = 21), posterior-stabilized (PS) (n = 20) and cruciate-retaining (CR) (n = 19). Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee Society Score (KSS), UCLA-activity score, ML instability scores and both radiographic and clinical data were compared between groups.

Results

ML stability was significantly better in CCK designs (86% grade 0) compared to CR (37% grade 0) (p = 0.004) but not PS (70% grade 0) designs. No grade II instability was present in CCK and PS implants compared to 16% of CR implants. KSS and UCLA-activity score were higher in CCK designs compared to PS (p = 0.027, p = 0.041) and CR designs (p < 0.001, p = 0.007). OKS and FJS were higher in CCK designs compared to CR (p = 0.025, p = 0.008) but not to PS.

Conclusion

The use of a CCK design to compensate for the lateral laxity in high-grade varus OA knees allowed to refrain from a medial release. CCK designs displayed improved clinical stability and better functionality as well as subjective outcome scores compared to less-constrained designs.

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Funding

This study is part of Limburg Clinical Research Center supported by Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.

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Author notes

  1. William Colyn and J. Neirynck share equal first authorship.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, AZ Turnhout, Rubenstraat 166, Turnhout, Belgium

    William Colyn & E. Vanlommel

  2. Faculty of Medicine and Life Sciences, UHasselt, Hasselt University, 3590, Diepenbeek, Belgium

    William Colyn & J. Bellemans

  3. Department Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium

    William Colyn

  4. Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, Louvain, Belgium

    J. Neirynck

  5. Department of Orthopaedic Surgery, RZ Tienen, Kliniekstraat 45, Tienen, Belgium

    J. Neirynck

  6. I-BioStat, University Hasselt, Martelarenlaan 42, Hasselt, Belgium

    L. Bruckers

  7. Department of Orthopaedic Surgery, ZOL Genk, Schiepse Bos 6, Genk, Belgium

    J. Bellemans

  8. GRIT Belgian Sports Clinic, Engels Plein 35/103, Leuven, Belgium

    J. Bellemans

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  1. William Colyn
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  5. J. Bellemans
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Contributions

Every author was involved in each part of this study including. Conception or design of the work. Data collection. Data analysis and interpretation. Drafting the article. Critical revision of the article. Final approval of the version to be published.

Corresponding author

Correspondence to William Colyn.

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The author(s) declare that they have no competing interests.

Ethical approval

Approval for this study was obtained by the Ethical Committee at B (19/0097U, B-nr: B371202042789).

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An informed consent was given by each participant of the study.

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Colyn, W., Neirynck, J., Vanlommel, E. et al. Primary constrained-condylar-knee designs outperform posterior-stabilized and cruciate-retaining designs in high-grade varus osteoarthritic knees during short-term follow-up: a pilot study. Arch Orthop Trauma Surg 143, 1593–1598 (2023). https://doi.org/10.1007/s00402-022-04447-9

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  • DOI: https://doi.org/10.1007/s00402-022-04447-9

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