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Survivorship and Functional Outcomes of Condylar-Stabilized Total Knee Arthroplasty Designs: An Analysis of the
Vishal Hegde1, Isabella Zaniletti2, Anirudh Buddhiraju1
1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Background:
The use of condylar-stabilized (CS) designs in total knee arthroplasty (TKA) is increasing. However, CS designs lack consistent classification and data examining survivorship. This study assessed revision risk and patient-reported outcome measures (PROMs) among CS designs and compared them to cruciate-retaining (CR) and posterior-stabilized (PS) designs.
Methods:
The American Joint Replacement Registry was queried for patients aged 65 years or older undergoing elective TKA with CR (n = 111,622), PS (n = 282,487), or CS (n = 162,648) designs between January 2012 and December 2021, with a minimum two-year follow-up. The CS designs were classified as anterior-stabilized (n = 96,897), ultracongruent (n = 29,427), medial-stabilized (n = 21,555), medial-pivot (n = 11,171), and lateral-stabilized (n = 3,598). Outcomes included all-cause revision, revision for infection, aseptic revision, and PROMs.
Results:
Compared to CR designs, medial-stabilized designs demonstrated lower all-cause (adjusted hazard ratio (aHR): 0.77, confidence interval (CI): 0.66 to 0.90, P < 0.001) and aseptic revision risk (aHR: 0.75, CI: 0.62 to 0.90, P = 0.002), lateral-stabilized designs had higher all-cause (aHR: 1.62, CI: 1.29 to 2.03, P < 0.001) and aseptic revision risk (aHR: 1.53, CI: 1.22 to 1.91, P < 0.001), and medial-pivot designs had higher all-cause revision risk (aHR: 1.23, CI: 1.02 to 1.48, P = 0.028). Posterior-stabilized designs demonstrated a higher aseptic failure risk (aHR: 1.09, CI: 1.01 to 1.17, P < 0.001) than CS designs. There was no significant difference in achieving the minimal clinically important difference (MCID) in PROMs between groups at one-year postoperatively.
Conclusions:
Condylar-stabilized designs demonstrate improved survivorship compared to PS and comparable revision risk to CR designs. Among CS designs, medial-stabilized designs demonstrate decreased revision risk, while lateral-stabilized and medial-pivot designs have a higher risk of revision. There was no difference in achieving MCID in PROMs among designs.
Level Of Evidence:
Therapeutic Level III.
