Varus-Valgus Constrained Implants With a Mobile-Bearing Articulation: Results of 367 Revision Total Knee Arthroplasties

Nicolas Reina, Christopher G. Salib, Mark W. Pagnano, Robert T. Trousdale, Matthew P. Abdel, Daniel J. Berry

Research output: Contribution to journalArticle

Abstract

Background: Varus-valgus constrained (VVC) implants are used for compromised ligamentous stability in revision total knee arthroplasties (TKAs). Mobile-bearing VVC implants may reduce rotational forces; yet, limited clinical data exist. The purpose of this study is to report mid-term risk of re-revision, complications, and clinical outcomes with a mobile-bearing VVC implant. Methods: Three hundred thirty-seven patients (367 TKAs) who underwent revision TKA with a mobile-bearing VVC implant between 1999 and 2013 at a single institution were reviewed. Mean age at revision was 67 years. Mean follow-up was 4 years. The main indications for revision were aseptic loosening in 158 cases (43%), reimplantation after 2-stage exchange arthroplasty in 120 (33%), instability in 61 (17%), and other in 28 (7%). Clinical outcomes were assessed by Knee Society Scores, and survivorship was analyzed with death as the competing risk. Results: The 5-year cumulative incidences of any re-revision or re-revision for aseptic loosening were 9% and 3%, respectively. Twenty-six knees (7%) were re-revised: 15 for infection, 6 for aseptic loosening, and 5 for other causes. There were 17 cases of irrigation and debridement, 10 cases of manipulations under anesthesia, and 9 cases of periprosthetic fractures. There were no bearing “spin-outs.” The mean Knee Society Scores improved from 45 preoperatively to 77 at most recent follow-up (P < .001). Conclusion: The functional improvement and 5-year cumulative incidence of revision of a mobile-bearing VVC implant demonstrated acceptable outcomes with no unique complications related to the mobile-bearing construct. Additional follow-up will be needed to determine long-term implant survivorship.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jan 1 2019

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Knee Replacement Arthroplasties
Survival Rate
Periprosthetic Fractures
Replantation
Incidence
Debridement
Arthroplasty
Knee
Anesthesia
Infection

Keywords

  • instability
  • mobile bearing
  • revision total knee arthroplasty
  • survivorship
  • varus-valgus constrained

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Varus-Valgus Constrained Implants With a Mobile-Bearing Articulation : Results of 367 Revision Total Knee Arthroplasties. / Reina, Nicolas; Salib, Christopher G.; Pagnano, Mark W.; Trousdale, Robert T.; Abdel, Matthew P.; Berry, Daniel J.

In: Journal of Arthroplasty, 01.01.2019.

Research output: Contribution to journalArticle

Reina, Nicolas ; Salib, Christopher G. ; Pagnano, Mark W. ; Trousdale, Robert T. ; Abdel, Matthew P. ; Berry, Daniel J. / Varus-Valgus Constrained Implants With a Mobile-Bearing Articulation : Results of 367 Revision Total Knee Arthroplasties. In: Journal of Arthroplasty. 2019.
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abstract = "Background: Varus-valgus constrained (VVC) implants are used for compromised ligamentous stability in revision total knee arthroplasties (TKAs). Mobile-bearing VVC implants may reduce rotational forces; yet, limited clinical data exist. The purpose of this study is to report mid-term risk of re-revision, complications, and clinical outcomes with a mobile-bearing VVC implant. Methods: Three hundred thirty-seven patients (367 TKAs) who underwent revision TKA with a mobile-bearing VVC implant between 1999 and 2013 at a single institution were reviewed. Mean age at revision was 67 years. Mean follow-up was 4 years. The main indications for revision were aseptic loosening in 158 cases (43{\%}), reimplantation after 2-stage exchange arthroplasty in 120 (33{\%}), instability in 61 (17{\%}), and other in 28 (7{\%}). Clinical outcomes were assessed by Knee Society Scores, and survivorship was analyzed with death as the competing risk. Results: The 5-year cumulative incidences of any re-revision or re-revision for aseptic loosening were 9{\%} and 3{\%}, respectively. Twenty-six knees (7{\%}) were re-revised: 15 for infection, 6 for aseptic loosening, and 5 for other causes. There were 17 cases of irrigation and debridement, 10 cases of manipulations under anesthesia, and 9 cases of periprosthetic fractures. There were no bearing “spin-outs.” The mean Knee Society Scores improved from 45 preoperatively to 77 at most recent follow-up (P < .001). Conclusion: The functional improvement and 5-year cumulative incidence of revision of a mobile-bearing VVC implant demonstrated acceptable outcomes with no unique complications related to the mobile-bearing construct. Additional follow-up will be needed to determine long-term implant survivorship.",
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AU - Salib, Christopher G.

AU - Pagnano, Mark W.

AU - Trousdale, Robert T.

AU - Abdel, Matthew P.

AU - Berry, Daniel J.

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N2 - Background: Varus-valgus constrained (VVC) implants are used for compromised ligamentous stability in revision total knee arthroplasties (TKAs). Mobile-bearing VVC implants may reduce rotational forces; yet, limited clinical data exist. The purpose of this study is to report mid-term risk of re-revision, complications, and clinical outcomes with a mobile-bearing VVC implant. Methods: Three hundred thirty-seven patients (367 TKAs) who underwent revision TKA with a mobile-bearing VVC implant between 1999 and 2013 at a single institution were reviewed. Mean age at revision was 67 years. Mean follow-up was 4 years. The main indications for revision were aseptic loosening in 158 cases (43%), reimplantation after 2-stage exchange arthroplasty in 120 (33%), instability in 61 (17%), and other in 28 (7%). Clinical outcomes were assessed by Knee Society Scores, and survivorship was analyzed with death as the competing risk. Results: The 5-year cumulative incidences of any re-revision or re-revision for aseptic loosening were 9% and 3%, respectively. Twenty-six knees (7%) were re-revised: 15 for infection, 6 for aseptic loosening, and 5 for other causes. There were 17 cases of irrigation and debridement, 10 cases of manipulations under anesthesia, and 9 cases of periprosthetic fractures. There were no bearing “spin-outs.” The mean Knee Society Scores improved from 45 preoperatively to 77 at most recent follow-up (P < .001). Conclusion: The functional improvement and 5-year cumulative incidence of revision of a mobile-bearing VVC implant demonstrated acceptable outcomes with no unique complications related to the mobile-bearing construct. Additional follow-up will be needed to determine long-term implant survivorship.

AB - Background: Varus-valgus constrained (VVC) implants are used for compromised ligamentous stability in revision total knee arthroplasties (TKAs). Mobile-bearing VVC implants may reduce rotational forces; yet, limited clinical data exist. The purpose of this study is to report mid-term risk of re-revision, complications, and clinical outcomes with a mobile-bearing VVC implant. Methods: Three hundred thirty-seven patients (367 TKAs) who underwent revision TKA with a mobile-bearing VVC implant between 1999 and 2013 at a single institution were reviewed. Mean age at revision was 67 years. Mean follow-up was 4 years. The main indications for revision were aseptic loosening in 158 cases (43%), reimplantation after 2-stage exchange arthroplasty in 120 (33%), instability in 61 (17%), and other in 28 (7%). Clinical outcomes were assessed by Knee Society Scores, and survivorship was analyzed with death as the competing risk. Results: The 5-year cumulative incidences of any re-revision or re-revision for aseptic loosening were 9% and 3%, respectively. Twenty-six knees (7%) were re-revised: 15 for infection, 6 for aseptic loosening, and 5 for other causes. There were 17 cases of irrigation and debridement, 10 cases of manipulations under anesthesia, and 9 cases of periprosthetic fractures. There were no bearing “spin-outs.” The mean Knee Society Scores improved from 45 preoperatively to 77 at most recent follow-up (P < .001). Conclusion: The functional improvement and 5-year cumulative incidence of revision of a mobile-bearing VVC implant demonstrated acceptable outcomes with no unique complications related to the mobile-bearing construct. Additional follow-up will be needed to determine long-term implant survivorship.

KW - instability

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