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Managing instability in total knee arthroplasty with constrained and linked implants
Douglas D Naudie1, Cecil H Rorabeck
1Division of Orthopaedic Surgery, London Health Sciences Center, London, Ontario, Canada.
Instructional Course Lectures
|May 1, 2004
Summary
Managing total knee arthroplasty instability requires anticipating the need for constraint. Using the minimum necessary constraint, often a posterior-stabilized or nonlinked implant, is recommended for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Instability is a frequent complication in total knee arthroplasty (TKA).
- Anticipating and addressing the need for constraint is crucial for managing unstable TKAs.
Purpose of the Study:
- To outline the management principles for unstable total knee arthroplasty.
- To discuss the appropriate use of constrained implants in TKA.
Main Methods:
- Preoperative assessment including history, physical examination, and radiographic analysis.
- Selection of implant constraint based on ligamentous support and bone integrity.
Main Results:
- Stability in TKA can often be achieved with posterior-stabilized or nonlinked implants.
- Hinge prostheses may be necessary for severe cases, such as absent medial collateral ligament.
- Increased constraint can lead to stem-bone interface loosening, though not always clinically significant.
Conclusions:
- Judicious use of constraint is key in managing TKA instability.
- Careful preoperative planning guides the selection of appropriate constrained implants.
- While radiographic loosening is observed with constrained components, clinical failure is not consistently reported.