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Primary complex total knee arthroplasty with severe varus deformity and large bone defects: mid-term results of a consecutive series treated with primary implants

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Abstract

Introduction

In recent years, the use of constrained implants in complex primary TKA has gained popularity since these implants may better and more easily address severe instability present in complex primary cases (CPC). However, the need for a constrained TKA in CPC is controversial. We hypothesized that a standard TKA may be successful in most of CPC and that an intraoperative switching to a constrained device is rarely need even in the presence of severe instability and bone loss.

Materials and methods

A consecutive series of 24 CPC (28 knees) were analysed retrospectively. Inclusion criteria were a femoro-tibial angle > 12° and bone defect of grade 2–3 (group 1). Forty-eight patients (52 knees) were analysed as controls (group 2). Patients were followed up clinically and radiographically up to a minimum of 5 years.

Results

In group 1, a PS was used in 24 knees and a CR in 4. In no patient, a CCK or RHK was implanted. Bone defect was treated with bone cement plus cortical screws in 15 knees (53.5%), a medial wedge in 8 (28.5%), a medial wedge plus bone grafting with cancellous screws in 5 (17.8%). Metaphyseal sleeve or cone was not used. At the last follow-up, no significant difference was found in the clinical scores between the 2 groups.

Conclusion

In CPC with marked varus deformity, instability and bone loss, the use of primary TKA is associated with a clinical outcome comparable to standard cases. Ligamentous balancing may be addressed using primary implants and simple cost-effective techniques may be used to manage an extensive bone loss. In most CPC, an intraoperative switching to a constrained device is not necessary.

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Abbreviations

TKA:

Total knee arthroplasty

CR:

Cruciate retaining

PS:

Posterior stabilized

CCK:

Condylar constrained knee

RHK:

Rotating hinge knee

FTA:

Femur-tibial angle

HKA:

Hip-knee-ankle axis

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Funding

No funds, grants or other supports were received for this study.

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Authors and Affiliations

  1. Department of Anatomical, Histological, Medico Legal and Orthopaedic Sciences, University La Sapienza, Rome, Italy

    Gianluca Cinotti, Fabiano Perfetti, Paolo Petitti & Giuseppe Giannicola

Authors
  1. Gianluca Cinotti
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  2. Fabiano Perfetti
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  3. Paolo Petitti
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  4. Giuseppe Giannicola
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Contributions

GC contributed to analysis of data, writing of the manuscript; FP was involved in edition of manuscript; PP contributed to data collection; GG was involved in data analysis, manuscript redaction.

Corresponding author

Correspondence to Gianluca Cinotti.

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Conflict of interest

None of the authors have conflicts to declare related to this study. The authors alone are responsible for the content and writing of the article.

Ethical approval

Ethical approval was waived by the local Ethics Committee of University in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care in accordance with the ethical standards of the institutional and national research committee and with the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Cinotti, G., Perfetti, F., Petitti, P. et al. Primary complex total knee arthroplasty with severe varus deformity and large bone defects: mid-term results of a consecutive series treated with primary implants. Eur J Orthop Surg Traumatol 32, 1045–1053 (2022). https://doi.org/10.1007/s00590-021-03074-1

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  • DOI: https://doi.org/10.1007/s00590-021-03074-1

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