Total knee implant posterior stabilised by a third condyle: Design evolution and post-operative complications - 01/12/16
, A. Peltier, V. Villa, E. Servien, P. Neyret
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Abstract |
Background |
Despite excellent long-term outcomes, posterior stabilisation by a third condyle continues to receive unwarranted criticism regarding patellar complications and instability.
Hypothesis |
Complication rates with a tri-condylar posterior-stabilised implant are similar to those with other posterior-stabilised prostheses and have diminished over time due to improvements in prosthesis design.
Material and methods |
Post-operative complications and revision rates were assessed retrospectively in a prospective cohort of 4189 consecutive patients who had primary total knee arthroplasty (TKA) using a tri-condylar posterior-stabilised implant (Wright-Tornier) and were then followed-up for at least 24 months. The analysis included 2844 knees. The prosthesis generations were HLS1®, n=20; HLS2®, n=220; HLS Evolution®, n=636; HLS Noetos®, n=1373; and HLS KneeTec®, n=595. Complications were compared across generations by applying Fisher's exact test, and survival was compared using the Kaplan-Meier method.
Results |
At last follow-up, there had been 341 (12%) post-operative complications in 306 (10.8%) knees, including 168 (5.9%) related to the implant, 41 (1.4%) infections, and 132 (4.6%) secondary complications unrelated to the implant. Re-operation was required for 200 complications (7%), including 87 (3.1%) consisting in revision of the prosthesis. Implant-related complications were stiffness (n=67, 2.4%), patellar fracture (n=34, 1.2%), patellar clunk syndrome (n=25, 0.9%), patellar loosening (n=3, 0.1%), tibial/femoral loosening (n=15, 0.5%), polyethylene wear (n=3, 0.1%), and implant rupture (n=1, 0.04%). Significant differences across generations were found for stiffness (P<0.0001), patellar fracture (P=0.03), clunk syndrome (P=0.03), and polyethylene wear (P=0.004), whose frequencies declined from one generation to the next. Overall 10-year survival was 92% with no significant difference across generations (P=0.1).
Discussion |
Outcomes of tri-condylar posterior-stabilised TKA are similar to those obtained using other posterior-stabilised implants. Neither patellar complications nor instability are more common, and improvements in implant design have contributed to correct early flaws.
Level of evidence |
IV, historical cohort, retrospective assessment of prospectively collected data.
Le texte complet de cet article est disponible en PDF.Keywords : Total knee arthroplasty, Complications, Posterior stabilisation, Third midline condyle, Implant design
Plan
Vol 102 - N° 8
P. 1061-1068 - décembre 2016 Retour au numéro
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