Abstract
Instability after TKA can result from ligament imbalance, attenuation of soft tissues, or ligament disruption. Flexion instability has been reported after both CR and PS TKA. However, the clinical manifestations of flexion instability can be quite variable. Symptoms of flexion instability include pain and swelling after activity. Bracing occasionally can be helpful. Revision options to treat flexion instability include tibial insert exchange and revision to increase constraint. However, more favorable results have been reported using implants with varus-valgus constraint.
Constrained mechanisms include a varus-valgus constrained PS post or hinge. The constrained post relies on the mechanical function of the post to provide stability which may deform or wear in-vivo leading to recurrent instability if used for a completely deficient collateral ligament. The hinge, which provides more rigid constraint, is indicated for collateral ligament deficiency. However, the additional constraint also results in greater bone-implant interface stresses, which may be mitigated by use of stem fixation to minimise risk of loosening.
