Skip to main content

Advertisement

Log in

Increased constraint of rotating hinge knee prosthesis is associated with poorer clinical outcomes as compared to constrained condylar knee prosthesis in total knee arthroplasty

  • Original Article • KNEE - ARTHROPLASTY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate whether there are any differences in patient-reported outcome measures between semi-constrained condylar constrained knee (CCK) and fully constrained rotating hinge knee (RHK) prostheses in midterm follow-up. We reviewed prospectively collected data of our hospital arthroplasty registry between 2007 and 2014. Thirty-nine patients were identified to have RHK prosthesis TKA and matched for a number of primary/revision TKA, gender, age, body mass index and pre-operative clinical scores to a control group of 78 patients with CCK TKA. Patient demographics, range of movement, varus/valgus deformity, Short Form 36 (SF-36) scores, Oxford Knee Score (OKS), Knee Society Score (KSS) and patient satisfaction were evaluated. Pre-operatively, the RHK and the control group of CCK had similar demographics, proportion of primary/revision TKA and baseline clinical scores (p > 0.05). At 2-year follow-up, patients with CCK prostheses had significantly better clinical outcomes as compared to patients with RHK prosthesis in terms of KSS functional scores, OKS, SF-36 sub-domains of physical functioning, physical role functioning and physical component score. We conclude that at midterm follow-up of 2 years, the CCK patients as compared to RHK patients reported better clinical and functional outcomes in terms of OKS, KSS functional score and SF-36 with a greater proportion of patients who were satisfied and had their expectations met by surgery. Further biomechanical studies are needed to investigate the association between component constraint and clinical outcomes for these prostheses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Malcolm TL, Bederman SS, Schwarzkopf R (2016) Outcomes of varus valgus constrained versus rotating-hinge implants in total knee arthroplasty. Orthopedics 39(1):e140–e148. https://doi.org/10.3928/01477447-20151228-07

    Article  PubMed  Google Scholar 

  2. Morgan H, Battista V, Leopold SS (2005) Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg 13:515–524

    Article  Google Scholar 

  3. Vasso M, Beaufils P, Schiavone Panni A (2013) Constraint choice in revision knee arthroplasty. Int Orthop 37:1279–1284. https://doi.org/10.1007/s00264-013-1929-y

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hwang SC, Kong JY, Nam DC et al (2010) Revision total knee arthroplasty with a cemented posterior stabilized, condylar constrained or fully constrained prosthesis: a minimum 2-year follow-up analysis. Clin Orthop Surg 2:112–120. https://doi.org/10.4055/cios.2010.2.2.112

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hossain F, Patel S, Haddad FS (2010) Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res 468:1221–1228. https://doi.org/10.1007/s11999-009-1204-0

    Article  PubMed  PubMed Central  Google Scholar 

  6. Shen C, Lichstein PM, Austin MS, Sharkey PF, Parvizi J (2014) Revision knee arthroplasty for bone loss: choosing the right degree of constraint. J Arthroplasty 29:127–131. https://doi.org/10.1016/j.arth.2013.04.042

    Article  PubMed  Google Scholar 

  7. Bistolfi A, Massazza G, Rosso F, Crova M (2012) Rotating-hinge total knee for revision total knee arthroplasty. Orthopedics 35(3):e325–e330. https://doi.org/10.3928/01477447-20120222-34

    Article  PubMed  Google Scholar 

  8. Beard DJ, Harris K, Dawson J, Doll H et al (2015) Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol 68(1):73–79. https://doi.org/10.1016/j.jclinepi.2014.08.009

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee WC, Kwan YH, Chong HC, Yeo SJ (2017) The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25(11):3354–3359. https://doi.org/10.1007/s00167-016-4208-9

    Article  PubMed  Google Scholar 

  10. Escobar A, Quintana JM, Bilbao A, Aróstegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage 15(3):273–280

    Article  CAS  Google Scholar 

  11. Thornhill TS, Dalziel RW, Sledge CB (1982) Alternatives to arthrodesis for the failed total knee arthroplasty. Clin Orthop Relat Res 170:131–140

    Google Scholar 

  12. Rosenberg AG, Verner JJ, Galante JO (1991) Clinical results of total knee revision using the total condylar III prosthesis. Clin Orthop Relat Res 273:83–90

    Google Scholar 

  13. Rand JA, Bryan RS (1988) Results of revision total knee arthroplasties using condylar prostheses: a review of fifty knees. J Bone Joint Surg Am 70(5):738–745

    Article  CAS  Google Scholar 

  14. Schroer WC, Berend KR, Lombardi AV et al (2013) Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 28(8 Suppl):116–119. https://doi.org/10.1016/j.arth.2013.04.056

    Article  PubMed  Google Scholar 

  15. Sculco TP (2006) The role of constraint in total knee arthoplasty. J Arthroplasty 21(4 Suppl 1):54–56

    Article  Google Scholar 

  16. Yercan HS, Ait Si Selmi T, Sugun TS, Neyret P (2005) Tibiofemoral instability in primary total knee replacement: a review. Part 1. Basic principles and classification. Knee 12:257–266. https://doi.org/10.1016/j.knee.2005.01.004

    Article  PubMed  Google Scholar 

  17. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper: why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13. https://doi.org/10.1097/00003086-200211000-00003

    Article  Google Scholar 

  18. Song SJ, Detch RC, Maloney WJ, Goodman SB, Huddleston JI (2014) Causes of instability after total knee arthroplasty. J Arthroplasty 29:360–364. https://doi.org/10.1016/j.arth.2013.06.023

    Article  PubMed  Google Scholar 

  19. Fuchs S, Sandmann C, Gerdemann G, Skwara A, Tibesku CO, Bottner F (2004) Quality of life and clinical outcome in salvage revision total knee replacement: hinged vs total condylar design. Knee Surg Sports Traumatol Arthrosc 12:140–143. https://doi.org/10.1007/s00167-003-0401-8

    Article  PubMed  Google Scholar 

  20. Farid YR, Thakral R, Finn HA (2013) Low-dose irradiation and constrained revision for severe, idiopathic, arthrofibrosis following total knee arthroplasty. J Arthroplasty 28:1314–1320. https://doi.org/10.1016/j.arth.2012.11.009

    Article  PubMed  Google Scholar 

  21. Farfalli GL, Aponte-Tinao LA, Ayerza MA, Muscolo DL, Boland PJ, Morris CD et al (2013) Comparison between constrained and semiconstrained knee allograft-prosthesis composite reconstructions. Sarcoma 2013:489652. https://doi.org/10.1155/2013/489652

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jacobs MA, Hungerford DS, Krackow KA, Lennox DW (1998) Revision total knee arthroplasty for aseptic failure. Clin Orthop Relat Res 226:78–85

    Google Scholar 

  23. Engh CA, McGovern TF, Bobyn JD, Harris WH (1992) A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg Am 74(7):1009–1020

    Article  CAS  Google Scholar 

  24. Stuart MJ, Larson JE, Morrey BF (1993) Reoperation after condylar revision total knee arthroplasty. Clin Orthop Relat Res 286:168–173

    Google Scholar 

  25. Goldberg VM, Figgie MP, Figgie HE 3rd, Sobel M (1988) The results of revision total knee arthroplasty. Clin Orthop Relat Res 226:86–92

    Google Scholar 

  26. Springer BD, Sim FH, Hanssen AD, Lewallen DG (2004) The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res 421:181–187

    Article  Google Scholar 

  27. Barrack RL, Lyons TR, Ingraham RQ, Johnson JC (2000) The use of a modular rotating hinge component in salvage revision total knee arthroplasty. J Arthroplasty 15(7):858–866

    Article  CAS  Google Scholar 

  28. Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF (2007) Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am 89(8):1735–1741

    PubMed  Google Scholar 

  29. Luttjeboer JS, Benard MR, Defoort KC, van Hellemondt GG, Wymenga AB (2016) Revision total knee arthroplasty for instability-outcome for different types of instability and implants. J Arthroplasty 31(12):2672–2676. https://doi.org/10.1016/j.arth.2016.06.062 (PMID: 27546470)

    Article  PubMed  Google Scholar 

  30. Yoon JR, Cheong JY, Im JT, Park PS, Park JO, Shin YS (2019) Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: a meta-analysis. PLoS ONE 14(3):e0214279. https://doi.org/10.1371/journal.pone.0214279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was performed at Singapore General Hospital, Singapore, Republic of Singapore.

Funding

No funds were received in support of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jason Beng Teck Lim.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lim, J.B.T., Pang, H.N., Tay, K.J.D. et al. Increased constraint of rotating hinge knee prosthesis is associated with poorer clinical outcomes as compared to constrained condylar knee prosthesis in total knee arthroplasty. Eur J Orthop Surg Traumatol 30, 529–535 (2020). https://doi.org/10.1007/s00590-019-02598-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02598-x

Keywords

Navigation