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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


For most revision total knee replacement there is associated soft tissue and bone loss. A constrained condylar implant can be useful in improving the stability of the knee after revision. Augmentation is commonly used to deal with bone loss on the femoral and tibial side of the joint. Stems are known to reduce the load at the interface of the femoral and tibial component and transfer the load into the medullary canals. There are problems with using stems in the revision setting however, which include: (1) increased cost, (2) difficulty with removal should further revision be necessary, (3) violation of the intramedullary canals if infection occurs, (4) increased operating time. For these reasons a CCK implant was developed without stems in 1998. The use of this device must be very selective and it is primarily used for severe valgus deformity in elderly patients. In a revision setting where there is good preservation of femoral and/or tibial bone but the need for increased constraint is present (e.g. unicompartmental, cruciate retaining knee) a CCK without stems can be used with good results. We retrospectively reviewed 36 primary constrained condylar knee implants without stem extensions from 1998 to 2000 in 31 patients with knees in 15 degrees valgus or greater. All patients were followed up for a minimum 10 years (range, 10 to 12 years). One patient had aseptic loosening and needed to be revised with stemmed components at 9 years post-surgery. Wear was found in two patients. One patient, with severe rheumatoid arthritis, had infection and required a two-stage re-implantation procedure. Patients who are very active or heavy body weight where stresses may be excessive at the implant bone interface should have stems utilised.