Greenberg Arieh, Braunstein Doris, Abughaduma Nada R, Gross Allen, Safir Oleg, Kuzyk Paul, Wolfstadt Jesse, Backstein David
Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, Canada.
J Arthroplasty. 2025 May 28. doi: 10.1016/j.arth.2025.05.088.
Constrained condylar knee (CCK) prostheses are commonly utilized in revision total knee arthroplasty (rTKA) when additional constraint is needed due to ligamentous insufficiency. However, data on long-term outcomes remain limited. This study evaluated the survivorship and complications of CCK implants over a minimum 10-year follow-up, extending up to 23 years.
We retrospectively analyzed 345 rTKA procedures with CCK implants performed between 2001 and 2014. The cohort included 190 women (55%) and 155 men (45%), with a mean age of 69 years (range, 36 to 92). The mean follow-up duration was 13.5 years (range, 10 to 23.3 years). The primary indication for initial TKA was osteoarthritis (81%). Revisions were performed for aseptic loosening (23.2%), infection (22.9%), malrotation/malalignment (14.2%), and instability (13%). Femoral augments were used in 238 cases, tibial augments in 62 cases, and void fillers for bone defects in 25 patients. Kaplan-Meier survival analysis assessed implant longevity, defining failure as revision for any cause and revision due to aseptic loosening.
Kaplan-Meier analysis demonstrated favorable long-term implant survivorship. All-cause revision-free survival was 95.1% (95% CI [confidence interval]: 92.7 to 97.5) at 5 years and 93.6% (95% CI: 91.0 to 96.2) from 10 years onward. Survival free from aseptic loosening was 98.5% (95% CI: 97.1 to 99.9) at 5 years and 97.9% (95% CI: 96.3 to 99.5) through 20 years. The number of knees at risk declined over time, from 314 at 10 years to 16 at 20 years. A total of 25 complications occurred at a mean of 2.9 years post-revision, with 22 requiring surgical intervention. The leading causes for re-revision were infection (54.5%) and aseptic loosening (31.8%).
The CCK implants demonstrate favorable long-term survivorship in rTKA at a minimum 10-year follow-up. These findings support the continued use of CCK implants in rTKA with appropriate patient selection and careful surgical technique.
当因韧带功能不全需要额外的约束时，受限髁膝关节（CCK）假体常用于翻修全膝关节置换术（rTKA）。然而，关于长期疗效的数据仍然有限。本研究评估了CCK植入物在至少10年随访期（最长达23年）内的生存率和并发症情况。
我们回顾性分析了2001年至2014年间进行的345例采用CCK植入物的rTKA手术。该队列包括190名女性（55%）和155名男性（45%），平均年龄69岁（范围36至92岁）。平均随访时间为13.5年（范围10至23.3年）。初次全膝关节置换术的主要指征是骨关节炎（81%）。翻修的原因包括无菌性松动（23.2%）、感染（22.9%）、旋转不良/对线不良（14.2%）和不稳定（13%）。238例使用了股骨增强物，62例使用了胫骨增强物，25例患者使用了骨缺损填充剂。采用Kaplan-Meier生存分析评估植入物的使用寿命，将任何原因导致的翻修以及无菌性松动导致的翻修定义为失败。
Kaplan-Meier分析显示植入物具有良好的长期生存率。5年时无任何原因的翻修生存率为95.1%（95%置信区间[CI]：92.7至97.5），10年及以后为93.6%（95%CI：91.0至96.2）。5年时无无菌性松动的生存率为98.5%（95%CI：97.1至99.9），20年时为97.9%（95%CI：96.3至99.5）。处于风险中的膝关节数量随时间减少，从10年时的314例降至20年时的16例。总共发生了25例并发症，平均发生在翻修后2.9年，其中22例需要手术干预。再次翻修的主要原因是感染（54.5%）和无菌性松动（31.8%）结论：在至少10年的随访中，CCK植入物在rTKA中显示出良好的长期生存率。这些发现支持在合适的患者选择和谨慎的手术技术下，继续在rTKA中使用CCK植入物。
