Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA)
Background and purpose: In complex primary total knee arthroplasty (TKA), constrained condylar knee (CCK) or rotating hinge knee (RHK) designs may be required to provide stability or address bony deficiencies. We analyzed trends in incidence of these designs in primary TKA and evaluated the mid- to...
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| Language: | English |
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Medical Journals Sweden
2025-02-01
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| Series: | Acta Orthopaedica |
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| Online Access: | https://actaorthop.org/actao/article/view/42999 |
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| author | Jake von Hintze Ville Ponkilainen Annette W-Dahl Nils P Hailer Ove Furnes Anne M Fenstad Mona Badawy Alma B Pedersen Martin Lindberg-Larsen Mika J Niemeläinen Keijo Mäkelä Antti Eskelinen |
| author_facet | Jake von Hintze Ville Ponkilainen Annette W-Dahl Nils P Hailer Ove Furnes Anne M Fenstad Mona Badawy Alma B Pedersen Martin Lindberg-Larsen Mika J Niemeläinen Keijo Mäkelä Antti Eskelinen |
| author_sort | Jake von Hintze |
| collection | DOAJ |
| description |
Background and purpose: In complex primary total knee arthroplasty (TKA), constrained condylar knee (CCK) or rotating hinge knee (RHK) designs may be required to provide stability or address bony deficiencies. We analyzed trends in incidence of these designs in primary TKA and evaluated the mid- to long-term survivorship of CCK and RHK in 4 Nordic countries.
Methods: From 2000 to 2017, 5,134 CCK and 2,515 RHK primary TKAs were identified from the NARA database. Kaplan–Meier (K–M) survival and flexible parametric survival model (FPSM) analyses were performed to estimate revision risk, expressed as hazard ratio (HR) with 95% confidence intervals (CI), with minimally stabilized (MS) TKA acting as the control group (n = 456,137).
Results: The incidence of CCK and RHK implants increased significantly in Finland, while it was moderate in Denmark, Norway, and Sweden. With revision for any reason as the endpoint the 15-year K–M cumulative revision risk for RHK was 13.6% (CI 10.4–16.7) and for CCK it was 11.3% (CI 9.1–13.5). Compared with MS TKA, the hazard ratio for revision was 2.1 (CI 1.8–2.3) for CCK and 2.5 (CI 2.1–2.8) for RHK. Periprosthetic joint infection (PJI) was the most common reason for revision, accounting for 44% of CCK and 47% of RHK cases. After excluding revisions for PJI, the hazard ratio remained high for both designs, at 1.5 (CI 1.3–1.7) for CCK and 1.6 (CI 1.3–2.0) for RHK compared with MS.
Conclusion: The incidence of CCK and RHK increased during the study period. Both designs showed consistent 15-year revision risks of 11–14%, with no major differences between them. The higher revision risk compared with MS TKAs may reflect the complexity of the surgeries.
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| format | Article |
| id | doaj-art-eede5b78478d43bdbc32b020c36bd331 |
| institution | Kabale University |
| issn | 1745-3674 1745-3682 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj-art-eede5b78478d43bdbc32b020c36bd3312025-02-06T15:06:28ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822025-02-019610.2340/17453674.2025.42999Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA)Jake von Hintze0https://orcid.org/0000-0003-4981-5174Ville Ponkilainen1https://orcid.org/0000-0002-5026-4560Annette W-Dahl2https://orcid.org/0000-0003-4053-7358Nils P Hailer3https://orcid.org/0000-0002-3233-2638Ove Furnes4https://orcid.org/0000-0001-8223-2515Anne M Fenstad5https://orcid.org/0000-0002-6429-0153Mona Badawy6Alma B Pedersen7https://orcid.org/0000-0002-3288-9401Martin Lindberg-Larsen8https://orcid.org/0000-0002-4483-677XMika J Niemeläinen9https://orcid.org/0000-0002-9438-111XKeijo Mäkelä10Antti Eskelinen11https://orcid.org/0000-0003-0302-0253Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, FinlandFaculty of Medicine and Health Technology, University of Tampere and Tampere University Hospital, Tampere, FinlandSwedish Arthroplasty Register, and Department of Clinical Sciences Lund, Orthopedics, Lund University, SwedenDepartment of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Uppsala, SwedenNorwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, NorwayNorwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, NorwayCoastal Hospital in Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, NorwayDanish Knee Arthroplasty Registry, Department of Clinical Epidemiology, Aarhus University Hospital, Denmark Danish Knee Arthroplasty Registry, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, DenmarkCoxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, FinlandThe Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; Department of Orthopaedics and Traumatology, Turku University Hospital, and University of Turku, Turku, FinlandCoxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland Background and purpose: In complex primary total knee arthroplasty (TKA), constrained condylar knee (CCK) or rotating hinge knee (RHK) designs may be required to provide stability or address bony deficiencies. We analyzed trends in incidence of these designs in primary TKA and evaluated the mid- to long-term survivorship of CCK and RHK in 4 Nordic countries. Methods: From 2000 to 2017, 5,134 CCK and 2,515 RHK primary TKAs were identified from the NARA database. Kaplan–Meier (K–M) survival and flexible parametric survival model (FPSM) analyses were performed to estimate revision risk, expressed as hazard ratio (HR) with 95% confidence intervals (CI), with minimally stabilized (MS) TKA acting as the control group (n = 456,137). Results: The incidence of CCK and RHK implants increased significantly in Finland, while it was moderate in Denmark, Norway, and Sweden. With revision for any reason as the endpoint the 15-year K–M cumulative revision risk for RHK was 13.6% (CI 10.4–16.7) and for CCK it was 11.3% (CI 9.1–13.5). Compared with MS TKA, the hazard ratio for revision was 2.1 (CI 1.8–2.3) for CCK and 2.5 (CI 2.1–2.8) for RHK. Periprosthetic joint infection (PJI) was the most common reason for revision, accounting for 44% of CCK and 47% of RHK cases. After excluding revisions for PJI, the hazard ratio remained high for both designs, at 1.5 (CI 1.3–1.7) for CCK and 1.6 (CI 1.3–2.0) for RHK compared with MS. Conclusion: The incidence of CCK and RHK increased during the study period. Both designs showed consistent 15-year revision risks of 11–14%, with no major differences between them. The higher revision risk compared with MS TKAs may reflect the complexity of the surgeries. https://actaorthop.org/actao/article/view/42999ArthroplastyImplantsKnee |
| spellingShingle | Jake von Hintze Ville Ponkilainen Annette W-Dahl Nils P Hailer Ove Furnes Anne M Fenstad Mona Badawy Alma B Pedersen Martin Lindberg-Larsen Mika J Niemeläinen Keijo Mäkelä Antti Eskelinen Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA) Acta Orthopaedica Arthroplasty Implants Knee |
| title | Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA) |
| title_full | Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA) |
| title_fullStr | Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA) |
| title_full_unstemmed | Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA) |
| title_short | Incidence of constrained condylar and hinged knee implants and mid- to long-term survivorship: a register-based study from the Nordic Arthroplasty Register Association (NARA) |
| title_sort | incidence of constrained condylar and hinged knee implants and mid to long term survivorship a register based study from the nordic arthroplasty register association nara |
| topic | Arthroplasty Implants Knee |
| url | https://actaorthop.org/actao/article/view/42999 |
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