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Clinical outcome and survival rate of condylar constrained knee prosthesis in revision total knee arthroplasty: an average nine point six year follow-up

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Abstract

Purpose

Condylar constrained knee prostheses (CCK) are increasingly used in revision total knee arthroplasty (rTKA), but the clinical effectiveness and long-term survival remain a debate. The purpose of this study is to report the long-term clinical and radiographic outcome, implant survival rate, and surgical safety of revision total knee arthroplasty with condylar constrained knee prosthesis.

Methods

A retrospective cohort study was performed on patients undergoing rTKA with CCK. The cases who received rTKA with CCK from January 2005 to January 2022 were selected. The duration of operation, the estimated perioperative blood loss, and the intraoperative blood transfusion rate were recorded to evaluate surgical safety. The pain visual analog scale (VAS), range of motion (ROM), the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Oxford knee score (OKS) was recorded to assess clinical outcome. Standard anteroposterior, lateral, skyline and long-standing AP radiographs of the lower limbs were conducted to assess radiographic outcome. Implant survival was analyzed by Kaplan–Meier survival estimates.

Results

Fifty-five cases were followed up for an average of 9.6 years (1–18 years), including 16 males and 38 females, with an average age of 66 and an average BMI of 26.9 kg/m2. The  main reasons for revision were periprosthetic infection (32 knees, 58.2%) and aseptic loosening (13 knees, 23.6%). The duration of operation was 149 ± 56.2 min. The perioperative blood loss was 973.6 ± 421.6 ml. At the last follow-up, VAS (8.0 ± 1.1 to 1.3 ± 1.4), ROM (82.7° ± 26.1° to 108.4° ± 11.8°), HSS (45.0 ± 10.4 to 85.3 ± 8.6), KSKS (38.4 ± 12.1 to 88.5 ± 12.0), KSFS (19.6 ± 12.9 to 68.8 ± 15.1), WOMAC (67.9 ± 12.5 to 14.4 ± 9.5), and OKS (9.9 ± 4.2 to 41.6 ± 7.7) were significantly improved (P < 0.001). A total of five complications were observed, all of which were periprosthetic infection. Non-progressive radiolucent lines were observed in 26 knees (47.3%). The 10-year survival rate for no operation was 96.0%. The ten year survival rate for no revision was 98.0%.

Conclusion

The use of CCK prosthesis for rTKA can achieve good long-term efficacy and prosthesis survival.

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Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Funding

This work was supported by the Beijing Natural Science Foundation (L232006), Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS; No. 2022-I2M-C&T-B-031), and the National High Level Hospital Clinical Research Funding (No. 2022-PUMCH-A-124, No. 2022-PUMCH-C-036).

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Authors and Affiliations

  1. Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Muyang Yu, Yiming Xu, Xisheng Weng & Bin Feng

  2. State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China

    Xisheng Weng

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All the authors participated in the design, performance, analysis, and drafting of this manuscript.

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Correspondence to Xisheng Weng or Bin Feng.

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Yu, M., Xu, Y., Weng, X. et al. Clinical outcome and survival rate of condylar constrained knee prosthesis in revision total knee arthroplasty: an average nine point six year follow-up. International Orthopaedics (SICOT) 48, 1179–1187 (2024). https://doi.org/10.1007/s00264-024-06096-6

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