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. 2020 Dec 23:23:18-24.
doi: 10.1016/j.jor.2020.12.013. eCollection 2021 Jan-Feb.

Options and limitations of implant constraint

S K S Marya  1 , Chandeep Singh  1
Affiliations

Options and limitations of implant constraint

S K S Marya et al. J Orthop. .

Abstract

With an ever-increasing number of revisions, the surgeons will be faced with the dilemma of choosing the right implant for the revision knee. The soft tissue viability governs the choice of an implant at the time of revision. The selection ranges from the cruciate-retaining to the rotating/fixed hinge implants. The surgeon needs to plan preoperatively, but usually, the final decisions are made intraoperative. As determining the amount of constraint necessary can be challenging, we have tried to lay down a few pointers, which would help to make that choice. The posterior stabilized implants can manage most revision knees; in certain situations where they cannot accommodate the flexion-extension gap imbalance, a varus-valgus constrained implant should be used. The rotating hinge implants are used for severe instabilities or loss of soft tissue or bone around the knee. The use of a higher constraint implant has its consequences like reduced life span and reduced function. Thus it is crucial to use the least amount of constraint as necessary - however, as much as required.

Keywords: Constraint; Revision knee; Revision total knee arthroplasty; Rotating hinge; Stems; Varus valgus constrained.

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Figures

Fig. 1
Fig. 1
Showing the deeper notch and box of the VVC compared to PS implant.
Fig. 2
Fig. 2
The Insert design difference between the PS, VVC & RHK.
Fig. 3a
Fig. 3a
Pre op X rays of Dislocated tibiofemoral articulation of TKR.
Fig. 3b
Fig. 3b
Post op films showing VVC implant in situ.
Fig. 4a
Fig. 4a
Pre op X rays of Failed TKR with medial tibial condyle collapse.
Fig. 4b
Fig. 4b
Post op showing defect built up with use of medial tibial wedge and then use of VVC implant.
Fig. 5
Fig. 5
S ROM noiles prosthesis.
Fig. 6a
Fig. 6a
Periprosthetic comminuted Fracture with loose Implant.
Fig. 6b
Fig. 6b
CT Scan Picture of the comminuted periprosthetic fracture.
Fig. 6c
Fig. 6c
Distal femur replacement prosthesis in situ.
Fig. 6d
Fig. 6d
Post op use of Distal femur replacement with RHK as the ligament attachments were all disrupted.
Fig. 7a
Fig. 7a
Pre op Infected TKR with static antibiotic loaded spacer insitu.
Fig. 7b
Fig. 7b
Post op showing that only build up was required and since ligaments were intact a PS articulation was used.
See this image and copyright information in PMC

References

    1. Babis G.C., Trousdale R.T., Morrey B.F. The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty. J Bone Joint Surg Am. 2002;84-A(1):64. - PubMed
    1. Fitzpatrick C.K., Clary C.W., Cyr A.J., Maletsky L.P., Rullkoetter P.J. Mechanics of post-cam engagement during simulated dynamic activity. J Orthop Res. 2013;31(9):1438–1446. - PMC - PubMed
    1. Jo A.R., Song E.K., Lee K.B., Seo H.Y., Kim S.K., Seon J.K. A comparison of stability and clinical outcomes in single-radius versus multi-radius femoral design for total knee arthroplasty. J Arthroplasty. 2014;29:2402–2406. - PubMed
    1. Adravanti P., Vasta S. Varus-valgus constrained implants in total knee arthroplasty: indications and technique. Acta Biomed. 2017;88(2S):112–117. doi: 10.23750/abm.v88i2-S.6521. Published 2017 Jun 7. - DOI - PMC - PubMed
    1. Park C.H., Bae J.K., Song S.J. Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty. Int Orthop. 2019;43(8):1831–1840. - PubMed