Survivorship of constrained polyethylene inserts in primary total knee replacements

Varus-valgus constrained (VVC) inserts are used in primary total knee arthroplasty (TKA) when stability cannot be achieved with a traditional insert. Concern has been raised regarding premature loosening and failure of these primary TKAs due to the increased load transfer through the prosthesis. This study seeks to assess the survival, clinical outcomes and radiographic assessment of VVC total knee inserts used in a single primary TKA system without diaphyseal stem extensions.

A consecutive cohort of 74 primary TKAs with VVC inserts was identified from an institutional database. A two-to-one matched group of 136 posterior-stabilized (PS) primary TKAs was generated from the same database. Survival analysis was assessed for all-cause revision surgery. Patient outcome measures were the Oxford Knee Score (OKS) and patient reported satisfaction. Radiographs were assessed in accordance with the Knee Society radiographic scoring system for radiolucency.

Survival rates at three and five years were 98.1% and 95.1% for the VVC liner group and 98.1% and 98.1% for the PS liner group, respectively. OKS improved from pre-op to post-op for both groups (p < .001). OKS was reduced in the VVC liner group compared to the PS liner group at latest available follow-up (p = .012). However, clinical satisfaction rates did not differ between the two groups. Small, non-progressive radiolucent lines existed on several radiographs; however, no components in either group were deemed radiographically loose.

The survivorship, clinical, and radiographic outcomes of VVC knees were similar to the PS comparison group at short- to mid-term follow-up.