Journal
JOURNAL OF ORTHOPAEDICS
Volume 24, Issue -, Pages 201-211Publisher
ELSEVIER
DOI: 10.1016/j.jor.2021.02.036
Keywords
Varus-valgus constraint; Constrained total knee; Primary total knee arthroplasty; Joint laxity; Coronal deformity
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The use of VVC implants in primary TKA seems to show improved functional outcomes and good mid-term survivorship. However, caution should be exercised due to the lack of long-term study data.
Purpose: Knee instability is considered one of the most frequent cause of failure after primary total knee arthroplasty (TKA). In order to address intraoperative instability, varus-valgus constrained knee implants (VVC) are increasingly utilized in primary TKA. Despite an increased risk of mechanical failure, short to mid-term results seem to be encouraging, but long-term results are still lacking. Methods: A systematic review of prospective and retrospective studies that reported clinical outcomes of patients with VVC systems in primary TKAs between 1990 and 2020 was performed. Results: In all, 28 articles met our inclusion criteria. A total of 2798 VVC implants were used in primary TKA. The all-cause revision-free survivorship was 95.2% at a mean follow-up of 7 years. Infection and aseptic loosening were the most common reasons for reoperation with an incidence of 1.8% and 1.7%, respectively. Overall complication rate was 9.6%, the most common complications were knee stiffness and infection with an incidence of 2.8% and 2.5%, respectively. Conclusions: VVC implants in primary TKA are associated with improved functional outcomes and good mid-term survivorship, comparable to lower level of constraint implants. Non-modular stemless seem to be reliable implants at mid-term follow-up. However, given the lack data coming from long-term studies, VVC implants should be used cautiously in primary TKA.
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