Constrained condylar knee without stem extensions for difficult primary total knee arthroplasty

Two hundred forty-eight constrained condylar total knee arthroplasties consecutively implanted without the use of diaphyseal stem extensions were studied in 180 patients. Preoperative deformity was severe (82% Ahlbäck grade 4-5). One hundred ninety-two knees (148 patients) were reviewed at mean 47-month follow-up (range: 24-72 months). Knee Society score improved from 36 to 89 points, and function score improved from 42 to 76 points. Failure rate was 2.5% (2 infections, 1 aseptic loosening, 1 supracondylar femoral fracture, and 1 tibial post fracture). Five (2.5%) knees had patellofemoral complications. Nonprogressive radiolucent lines were present in 16% of cases. Use of a nonmodular constrained condylar knee for primary severely damaged knees demonstrated reliable short- to mid-term results with a low complication rate and questioned the routine use of intramedullary stem extensions in all such cases.