Background: The decision to use a posterior stabilized (PS) or constrained condylar knee (CCK) articulation in revision total knee arthroplasty (RTKA) has traditionally been based on surgeon preference and knee stability. The purpose of this study is to compare various outcomes and survivorship in RTKA with PS or CCK articulations.
Methods: A retrospective comparative study of RTKA with CCK or PS articulations (PS = 106/CCK = 147) was performed with minimum 2-year follow-up. Exclusion criteria were patients with rotating hinged implants or non-CCK/PS constructs. Multivariate logistic regression models were constructed to determine whether implant articulation influenced (1) complications, (2) aseptic loosening, and (3) re-revision. Kaplan-Meier estimates of cumulative implant survival were constructed with revision as the failure variable.
Results: PS articulation was an independent predictor of increased postoperative knee flexion (6.4°, P = .010) and the knee society functional score (10.0, P = .002). Survivorship was significantly reduced for CCK revision articulations when all-cause re-revision was the primary endpoint (P = .0003, log-rank test of equality). The primary reason for re-revision in the CCK cohort was a recurrent/persistent infection of the operative knee (N = 16, 37.2%), followed by aseptic loosening (N = 13, 30.2%). PS articulations conferred a lower likelihood of re-revision (odds ratio [OR] 0.3, P = .001), but articulation design was not associated with complications (OR 0.5, P = .123) or aseptic loosening (OR 2.6, P = .143).
Conclusion: The PS articulation when used for appropriate indication conferred superior survivorship for the primary endpoint of all-cause re-revision and overall knee function when compared to the CCK articulation after RTKA. Implant articulation was not a predictor of aseptic loosening or complications.
Keywords: constrained condylar knee; outcomes; posterior stabilized; revision knee arthroplasty; survivorship.
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