Constraint in complex primary total knee arthroplasty: rotating hinge versus condylar constrained implants

Abstract

Introduction: Condylar constrained knee arthroplasties (CCKAs) and rotating hinge knee arthroplasties (RHKAs) achieved good outcomes in complex primary total knee arthroplasties (TKAs); however, long-term comparative studies are few. Using an arthroplasty registry, we sought to assess and compare in CCKAs and RHKAs: (1) the intra-operative rates of complications, (2) the survival rates, (3) the reasons for revision, and (4) the adjusted hazard ratios for failure.

Materials and methods: 1432 constrained implants in primary TKAs performed for non-oncological indications were included: 703 RHKAs, 729 CCKAs. The two groups were comparable regarding age and gender. Kaplan-Meier curves were used to compare survival rates, multivariate analyses to assess the hazard ratios for failures.

Results: The mean follow-up was 4.1 years (range 0-16.3) for CCKAs and 6.8 years (0-18.1) for RHKAs. The intra/peri-operative complications were similar in both the cohorts, with similar rates of femoral and tibial fractures. 10-year implant survival rates were similar in both the cohorts (91.9%, CI 95% 89.2-93.9% in RHKAs; 93.4%, CI 95% 90.3-95.6% in CCKAs). Periprosthetic infection was the most common reason for revision in the two cohorts, followed by aseptic loosening. Breakage occurred in 3 RHKAs (0.4%). CCKAs and RHKAs had a similar distribution of revision causes. Males aged less than 60 had significantly more failures, regardless the constraint degree. Unstemmed CCKAs significantly failed more than RHKAs and stemmed CCKAs.

Conclusions: Both modern CCKAs and RHKAs are viable long-term solutions in complex primary TKAs. More failures should be expected in males aged less than 60.

Level of evidence: IV, Therapeutic study.

Keywords: Condylar constrained knee; Constraint; Failure; Rotating hinge knee; Total knee arthroplasty.