When to Use a Condylar Constrained Insert in Non-Stemmed Posterior-Stabilized Total Knee Arthroplasty
| Autor: | Umaporn Uawisetwathana, Pichai Sansawat, Satit Thiengwittayaporn, Natthapong Hongku |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
musculoskeletal diseases
Male medicine.medical_specialty Clinical Decision-Making Prosthesis Design Condyle 03 medical and health sciences 0302 clinical medicine Medicine Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee Aged Retrospective Studies Orthodontics Varus deformity 030222 orthopedics Medial collateral ligament Posterior-stabilized biology Receiver operating characteristic business.industry Varus-valgus constrained prosthesis Soft tissue 030229 sport sciences Varus Middle Aged medicine.disease biology.organism_classification musculoskeletal system Valgus medicine.anatomical_structure Total knee arthroplasty Orthopedic surgery Ligament Surgery Original Article Female business Knee Prosthesis |
| Zdroj: | Clinics in Orthopedic Surgery |
| ISSN: | 2005-4408 |
| Popis: | Backgroud The constrained insert with non-stemmed tibial and femoral components can be used in the modern total knee arthroplasty (TKA) when soft-tissue balance and adequate stability from a posterior-stabilized (PS) insert cannot be achieved. This study aimed to identify the prevalence and predictive factors associated with the constrained insert use during primary TKA for varus deformity. Methods From August 2016 to March 2019, 554 primary TKAs were consecutively performed by one surgeon. The choice of using a conventional PS polyethylene insert versus a constrained insert was made by the surgeon, depending on the stability detected after an attempt to balance the soft tissue. The decision to convert to a constrained liner was made if the ligament could not be balanced, if flexion-extension gaps were mismatched, or if the varus-valgus opening was 3 mm or more when varus and valgus stress tests at 0° were applied. We retrospectively investigated the preoperative, intraoperative, and postoperative factors associated with the constrained insert use. Multiple logistic regression analysis was used to identify predictive factors of constrained insert use, and a receiver operating characteristic curve analysis was used to pinpoint a cutoff value of tibiofemoral varus angle. Results Constrained inserts were used in 130 of 497 varus knees (26.1%). A multivariate analysis revealed that the factors associated with an increased adjusted risk of constrained insert use included preoperative severe varus deformity (odds ratio [OR], 5.78; 95% confidence interval [CI], 2.75–12.16; p < 0.001) and severe release of soft tissue through the superficial medial collateral ligament (OR, 6.38; 95% CI, 2.94–13.85; p < 0.001). A preoperative anatomic tibiofemoral varus angle of > 19.8° was associated with the use of a constrained articulation with an area under the curve of 0.7 (95% CI, 0.4–0.8). Conclusions Prevalence of 26.1% for constrained insert use was found in this study. Preoperative anatomic tibiofemoral varus angle of > 19.8° and severe release of soft tissue through the superficial medial collateral ligament were associated with the use of a constrained articulation. The findings from this study will help surgeons to improve efficiency of surgical sequence planning and provide counseling to patients regarding the associated cost. |
| Databáze: | OpenAIRE |
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