title: Long-term outcomes of primary constrained condylar knee arthroplasty.
abstract: BACKGROUND
  Although constrained condylar knee (CCK) inserts are widely used for total knee arthroplasty (TKA), their long-term outcomes remain unclear. We sought to evaluate patients with at least 10 years' follow-up after CCK TKA to identify potential adverse events (osteolysis, loosening, constraint-mechanism failure), assess functional outcomes with special emphasis on range of motion, and determine prosthesis survival.
  
  
  OBJECTIVE
  Increasing constraint by implantation of a CCK insert does not increase the long-term frequencies of osteolysis or mechanical loosening.
  
  
  METHODS
  We studied 43 knees after Legacy(®) CCK TKA. The indication was severe deformity (n=20), pre-operative laxity (n=6), or failure to achieve intra-operative balancing (n=17). There were 41 patients with a mean age of 66 years (21-88). A history of one or more surgical procedures was noted for 27 (63%) knees. Outcome measures were the Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and change in the hip-knee-ankle (HKA) angle. Prosthesis survival was assessed using revision surgery for any reason or for reasons other than infection as the censoring criterion.
  
  
  RESULTS
  Complications other than venous thrombosis occurred in 16% of patients, including 3 who required revision surgery (septic loosening, n=2; and major instability in a patient with ipsilateral hip arthrodesis). No cases of osteolysis or aseptic loosening were recorded. Mean follow-up was 12.7 years (range, 10-14). At last follow-up, the HSS score had improved from 53 (26-83) pre-operatively to 80 (55-93), the KSS knee component from 42 (16-77) to 90 (77-99), and the KSS function component from 31 (0-80) to 61 (10-90) (P<0.001). Mean range of flexion increased from 109° (50°-140°) to 112° (90°-130°) (P=0.12). The HKA angle changed from 182°±15.5° (150°-210°) to 179.5°±2.5° (174°-184°) (P=0.5). The 11-year prosthesis survival rate was 88.5% (95% confidence interval, 0.69-0.94) overall and 97.7% (0.76-0.99) after excluding the cases of infection.
  
  
  CONCLUSIONS
  Long-term functional gains after CCK TKA were similar to those reported after standard posterior-stabilised TKA, with no cases of constraint-mechanism failure or osteolysis. The complication rate was higher, with decreased survival compared to standard TKA, but the knee deformities and/or instability were particularly severe and two-thirds of knees had a history of one or more surgical procedures.
authors.affiliation: Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France. Electronic address: pierre.cholewinski@hotmail.fr.
authors.forename: P
authors.initials: P
authors.lastname: Cholewinski
authors.affiliation: Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Putman
authors.affiliation: Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Vasseur
authors.affiliation: Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.
authors.forename: H
authors.initials: H
authors.lastname: Migaud
authors.affiliation: Université Lille Nord de France, 59000 Lille, France; Pôle de santé publique, laboratoire de biostatistique, CHRU de Lille, 154, rue du Docteur-Yersin, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Université Lille Nord de France, 59000 Lille, France; Pôle de santé publique, laboratoire de biostatistique, CHRU de Lille, 154, rue du Docteur-Yersin, Lille, France.
authors.forename: H
authors.initials: H
authors.lastname: Behal
authors.affiliation: Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Pasquier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000453:epidemiology*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D055815:Young Adult
keywords: Constrained prosthesis; Joint laxity; Knee; Total knee arthroplasty