Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes

A Garrido-Hidalgo; R García Crespo; B Rizo de Álvaro; B Alcobía-Díaz; G Aparicio; F Marco

doi:10.1016/j.recot.2024.04.003

Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes

Rev Esp Cir Ortop Traumatol. 2024 Apr 18:S1888-4415(24)00077-8. doi: 10.1016/j.recot.2024.04.003. Online ahead of print.

[Article in English, Spanish]

Authors

A Garrido-Hidalgo¹, R García Crespo², B Rizo de Álvaro², B Alcobía-Díaz², G Aparicio², F Marco³

Affiliations

¹ Department of Traumatology and Orthopedic Surgery, Clínico San Carlos Hospital, Madrid, Spain. Electronic address: anagh23@gmail.com.
² Department of Traumatology and Orthopedic Surgery, Clínico San Carlos Hospital, Madrid, Spain.
³ Department of Traumatology and Orthopedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain.

PMID: 38642736
DOI: 10.1016/j.recot.2024.04.003

Abstract

Introduction: Achieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA.

Material and methods: We conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10° deformity or 10mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates.

Results: A total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105°/0°. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7°), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1°). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8°. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening.

Conclusion: Our experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

Keywords: Artroplastia total de rodilla; Constrained; Constreñida; Knee prosthesis; No modular; Non-modular; Non-stemmed; Primary total knee arthroplasty; Prótesis de rodilla; Vástago.