Preoperative Clinical Characteristics of Severely Deformed Varus Knees Treated With Primary Constrained Condylar Arthroplasty: A Retrospective Descriptive Case Series
DOI:
https://doi.org/10.22317/jcms.v12i4.2193Keywords:
Knee Prosthesis, Arthroplasty, Replacement, Knee, Genu Varum, Joint Deformities, Joint InstabilityAbstract
Objectives: To describe the preoperative clinical and radiographic characteristics of severely deformed knees treated with primary constrained condylar knee (CCK) arthroplasty, including coronal deformity, instability, fixed flexion contracture, pain, and functional limitation.
Methods: This retrospective descriptive case series included 19 knees in 14 consecutive patients undergoing primary CCK arthroplasty at two private hospitals in Babylon and Karbala, Iraq, between January 2024 and March 2026. Of 77 procedures, 71 were primary and six revision arthroplasties. Standing full-length weight-bearing radiographs measured the hip–knee–ankle (HKA) angle. Manual stress examination assessed mediolateral and anteroposterior stability. The 1989 Knee Society Clinical Rating System assessed objective and functional domains. Knee-level and patient-level outcomes used denominators of 19 and 14, respectively. Analyses were descriptive, without inferential testing or adjustment for bilateral knees.
Results: Mean age was 63.8 ± 6.6 years (range 50–75); nine patients (64%) were female, and five (36%) had bilateral involvement. CCK procedures represented 26.8% of primary TKAs and 48.7% of 39 knees meeting severity criteria. All knees were varus, with a mean HKA angle of 154.5° ± 5.8° and mean absolute deviation from 180° of 25.5° ± 5.8° (range 17–37°); five (26%) deviated by ≥30°. No valgus knee received CCK. All knees had ≥10° mediolateral opening, 16 (84%) had ≥15°, and 17 (89%) had ≥5 mm anteroposterior translation. Fixed flexion contracture affected 12 knees (63%), exceeding 20° in five (26%). Severe pain occurred in nine knees (47%); 17 (89%) had severe or continual moderate pain. All patients required walking aids, 12 (86%) could not climb stairs, and 10 (71%) were housebound. Mean Knee and Function Scores were 6.6 ± 7.1 (range 0–22) and 7.1 ± 6.4 (range 0–20), respectively.
Conclusions: Severely deformed varus knees selected for primary CCK arthroplasty exhibited substantial instability, contracture, pain, and functional impairment. These findings characterize implant selection but do not establish its necessity or superiority over less-constrained alternatives.
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