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Updated: Mar 15, 2026

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Complex Primary Total Knee Arthroplasty: Long-Term Outcomes.

J Ryan Martin1, Taylor R Beahrs1, Casey R Stuhlman1

  • 1Mayo Clinic, Rochester, Minnesota.

The Journal of Bone and Joint Surgery. American Volume
|September 9, 2016
PubMed
Summary

Constrained knee implants show higher reoperation and revision rates compared to unconstrained ones. This study highlights increased risks with constrained designs in total knee arthroplasty over 20 years.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Arthroplasty Research

Background:

  • Severe knee deformities, instability, or bone loss may necessitate constrained or rotating-hinge total knee arthroplasty (TKA) prostheses.
  • Understanding the long-term outcomes of these specialized implants is crucial for patient care.

Purpose of the Study:

  • To compare patient demographics, long-term survival, and reasons for reoperation/revision between constrained (varus/valgus) and rotating-hinge TKA implants versus unconstrained implants.
  • To identify risk factors influencing the success of constrained TKA designs.

Main Methods:

  • Retrospective analysis of 28,667 primary TKAs (1979-2013), focusing on 427 varus/valgus constrained and 246 rotating-hinge cases.
  • Multivariate analysis of demographic data (age, sex, BMI) and preoperative diagnoses.

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  • Kaplan-Meier survival analysis and adjusted hazard ratios for reoperation and revision, compared to unconstrained TKA controls.

    • Main Results:

    • Significant demographic differences (age, sex, BMI) were observed across implant groups.
    • Constrained and rotating-hinge TKA groups exhibited decreased survival free of reoperation at 10 and 20 years (HR 1.74 and 2.07, respectively).
    • Higher adjusted hazard ratios for all-cause revision were found for varus/valgus constrained (1.65) and rotating-hinge (1.48) groups compared to unconstrained TKA.

    Conclusions:

    • The use of constrained implants in primary TKA is associated with increased rates of reoperation and revision.
    • Component revision rates at 10 and 20 years were significantly higher (>2x and >3x, respectively) for constrained TKA groups compared to unconstrained TKA.
    • Wear, osteolysis, infection, and fracture were primary drivers for revision in both constrained implant groups.