Revision Total Knee Arthroplasty with Use of a Constrained Condylar Knee Prosthesis

Young-Hoo Kim and Jun-Shik Kim

J Bone Joint Surg Am. 2009;91:1440-1447. doi:10.2106/JBJS.H.00425

Background: The major goals of revision total knee arthroplasty include good clinical and radiographic results with a low complication rate. A retrospective review of a case series of revision total knee arthroplasties with a constrained condylar prosthesis by a single surgeon was performed in order to ascertain the role of this prosthesis and to determine whether it provided satisfactory results.

Methods: Ninety-seven patients (114 knees) underwent revision total knee arthroplasty with use of a constrained condylar knee prosthesis. There were eighty-four men and thirteen women. The mean age at the time of the index surgery was sixty-five years. The primary diagnosis was predominantly osteoarthritis (96%). The most common reason for revision was aseptic loosening of a component (54%). The mean time from the primary to the revision total knee arthroplasty was 6.1 years (range, six weeks to twenty-four years). The mean duration of follow-up was 7.2 years.

Results: The mean Hospital for Special Surgery knee score and mean Knee Society knee and functional scores were 31, 35, and 16 points, respectively, before the operation and 83, 90, and 64 points at the time of the final follow-up. The preoperative and postoperative Western Ontario and McMaster Universities Osteoarthritis Index scores were 85 and 34.5 points, respectively. The complication rate was 9%. Five knees (4%) had a rerevision, and three knees (2.6%) had a quadriceps tendon rupture. Kaplan-Meier survivorship analysis, with revision or radiographic failure as the end point, revealed that the ten-year rate of survival of the components was 96% (95% confidence interval, 94% to 100%).

Conclusions: Revision total knee arthroplasty with use of a constrained condylar knee prosthesis had reproducible clinical success, but a complication rate of up to 9% can be expected at intermediate-term follow-up.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.