• Federica Rosso, Roberto Rossi, Francesco Benazzo, Matteo Ghiara, Davide Edoardo Bonasia, and Stefano Marco Paolo Rossi.
• Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy.
• Arch Orthop Trauma Surg. 2023 May 1; 143 (5): 267526812675-2681.

BackgroundTotal knee arthroplasty (TKA) in major deformities with ligament insufficiency may require a higher constraint, with bone sacrifice and concerns about long-term survivorship. Mid-level constraint liners have been recently introduced, but few studies described their outcomes. The aim of this study is to evaluate the short to mid-term outcomes of a constrained postero-stabilized (CPS) insert for primary TKA in moderate to severe deformities.MethodsAll patients who underwent TKA using a CPS liner in two centers between 2015 and 2017 were included in the study. The indications were: (1) valgus deformity type 2-3 partially correctable; (2) severe varus deformity with varus thrust; (3) post-traumatic deformity with major ligamentous insufficiency and any case of intra-operative ligament insufficiency. Patients were evaluated according to the Knee Society Scoring System (KSS), the Hospital for Special Surgery score (HSS), the Western Ontario and Mc Master University (WOMAC) and the Oxford Knee score (OKS). X-rays were evaluated according to the Knee Society Roentgenographic Evaluation System.ResultsForty-seven TKA were included, with an average age of 66.1 ± 10.3 years and an average follow-up of 68.4 ± 6 months. All patients demonstrated a moderate to severe pre-operative mediolateral instability. All the scores significantly improved (p < 0.0001). In 71.4% of cases, the outcomes were excellent or very good. There were no failures due to aseptic loosening but one failure due to a traumatic ligament rupture. The cumulative survivorship was 97.9% ± 2.1% at 84 months.ConclusionsThis mid-range constraint total knee replacement demonstrated promising outcomes and survival at mid-term follow-up.Level Of EvidenceIV (case series).© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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