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© 2005 the American Academy of Orthopaedic Surgeons
Constraint in Primary Total Knee Arthroplasty
Dr. Morgan is Acting Instructor, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA. Dr. Battista is Assistant Program Director, Orthopaedic Surgery Residency Program, William Beaumont Army Medical Center, El Paso, TX. Dr. Leopold is Associate Professor, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center.
The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Defense or the United States Government.
Reprint requests: Dr. Seth S. Leopold, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA 98195.
None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Morgan and Dr. Battista. Dr. Leopold or the department with which he is affiliated has received research or institutional support from Zimmer, Inc. Dr. Leopold or the department with which he is affiliated has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Zimmer, Inc. Dr. Leopold or the department with which he is affiliated serves as a consultant to or is an employee of Zimmer, Inc.
Instability is an important cause of failure following total knee arthroplasty. Increasing component constraint may reduce instability, but doing so also can cause increased forces to be transmitted to fixation and implant interfaces, which may lead to premature aseptic loosening. Constraint is defined as the effect of the elements of knee implant design that provides the stability needed to counteract forces about the knee after arthroplasty in the presence of a deficient soft-tissue envelope. Determining the amount of constraint necessary can be challenging. Most primary total knee arthroplasties are performed for knees without substantial deformity or the need for difficult ligament balancing; in these cases, either a posterior-stabilized or a posterior cruciate–retaining design is appropriate. In certain situations, such as patients with prior patellectomies, rheumatoid arthritis, or substantial preoperative deformities, a posterior-stabilized knee may be favored. With their large posts, varus-valgus constrained implants typically are reserved for patients with substantial coronal plane instability, which is difficult to balance with a posterior-stabilized or cruciate-retaining implant alone. Rotating-hinge knee implants usually are recommended for patients with severe deformity or instability that cannot be managed with a varus-valgus implant.
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