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The impact of posterior-stabilized vs. constrained polyethylene liners in revision total knee arthroplasty



Posterior stabilized (PS) and varus valgus constrained (VVC) knee polyethylene liners have been shown to confer excellent long-term functional results following revision total knee arthroplasty (rTKA). The purpose of this study was to compare outcomes of patients who underwent rTKA using either a PS or VVC liner.


A retrospective comparative study of 314 rTKA with either PS or VVC liner and a minimum follow-up time of two years was conducted. Patient demographics, complications, readmissions, and re-revision etiology and rates were compared between groups. Kaplan–Meier survivorship analysis was performed to estimate freedom from all-cause revision.


Hospital LOS (3.41 ± 2.49 vs. 3.34 ± 1.93 days, p = 0.793) and discharge disposition (p = 0.418) did not significantly differ between groups. At a mean follow-up of 3.55 ± 1.60 years, the proportion of patients undergoing re-revision did not significantly differ (19.1% vs. 18.7%, p = 0.929). In subgroup analysis of re-revision causes, the VVC cohort had superior survival from re-revision due to instability compared to the PS cohort (97.8% vs. 89.4%, p = 0.003). Freedom from re-revision due to aseptic loosening did not significantly differ between groups (85.2% vs. 78.8%, p = 0.436). Improvements in range of motion (ROM) from preoperative to latest follow-up were similar as well.


PS and VVC liners confer similar survivorship, complication rates, and overall knee ROM in rTKA. VVC liners were not associated with increased postoperative aseptic loosening and demonstrated superior freedom from re-revision due to instability. Future studies with longer follow-up are warranted to better determine significant differences in clinical outcomes between the two bearing options.

Level III evidence

Retrospective Cohort Study.

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Correspondence to Ran Schwarzkopf.

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RS is a paid consultant for Smith&Nephew and Intelijoint, and has stock options in Intelijoint and Gauss Surgical. MM is a paid consultant for Intelijoint and Conformis, receives royalties from Innomed and has stock options in CAIRA surgical. IS, CO, GB, UA, NS and JR have nothing to disclose.

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The present study was exempt from human-subjects review by our Institutional Review Board (IRB).

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Shichman, I., Oakley, C.T., Beaton, G. et al. The impact of posterior-stabilized vs. constrained polyethylene liners in revision total knee arthroplasty. Arch Orthop Trauma Surg 143, 995–1004 (2023).

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