title: Results of a Second-generation Constrained Condylar Prosthesis in Complex Primary and Revision Total Knee Arthroplasty: A Mean 5.5-Year Follow-up.
abstract: BACKGROUND
  The application of second-generation constrained condylar knee (CCK) prostheses has not been widely studied. This retrospective study was carried out to evaluate the clinical and radiographic outcomes of a second-generation CCK prosthesis for complex primary or revision total knee arthroplasty (TKA).
  
  
  METHODS
  In total, 51 consecutive TKAs (47 patients) were performed between June 2003 and June 2013 using second-generation modular CCK prostheses. The follow-up was conducted at 3rd day, 1st, 6th, and 12th months postoperatively and later annually. Anteroposterior (AP), lateral, skyline, and long-standing AP radiographs of the affected knees were taken. The Hospital for Special Surgery (HSS) Knee Score, the Knee Society Knee Score (KSKS), the Knee Society Function Score (KSFS), and range of motion (ROM) were also recorded. Heteroscedastic two-tailed Student's t-tests were used to compare the HSS score and the Knee Society score between primary and revision TKAs. A value of P < 0.05 was considered statistically significant.
  
  
  RESULTS
  Four knees (two patients) were lost to follow-up, and 47 knees (31 primary TKAs and 16 revision TKAs) had a mean follow-up time of 5.5 years. The mean HSS score improved from 51.1 ± 15.0 preoperatively to 85.3 ± 8.4 points at the final follow-up (P < 0.05). Similar results were observed in terms of the KSKS and KSFS, which improved from 26.0 ± 13.0 to 80.0 ± 12.2 and from 40.0 ± 15.0 to 85.0 ± 9.3 points, respectively (P < 0.05). No significant difference in the HSS, KSKS, KSFS, or ROM was found between primary and revision TKAs (P > 0.05). Two complications were observed in the revision TKA group (one intraoperative distal femur fracture and one recurrence of infection) while one complication (infection) was observed in the primary TKA group. No prosthesis loosening, joint dislocation, patella problems, tibial fracture, or nerve injury were observed. Radiolucent lines were observed in 4% of the knees without progressive osteolysis.
  
  
  CONCLUSIONS
  Second-generation modular CCK prostheses are a safe and practical treatment for both primary and revision knees that cannot be balanced. However, further studies focusing on different types of constrained prostheses are required to validate these results.
authors.affiliation: Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, China.
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Ye
authors.affiliation: Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, China.
authors.forename: De-Ting
authors.initials: DT
authors.lastname: Xue
authors.affiliation: Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, China.
authors.forename: Rong-Xin
authors.initials: RX
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000502:physiology / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies