Does the Total Condylar 3 Constrained Knee Prosthesis Predispose to Failure of Revision Total Knee Replacement?

Revision total knee replacement is often complicated by bone loss and synovitis, which can result in ligamentous laxity and imbalance. The Total Condylar 3 (TC3) constrained condylar geometry was developed to allow load sharing between the implant and the deficient soft-tissue attachments. However, many authors have suggested caution in the use of these devices because of the additional stresses imparted to the cement-bone interface1,2. We report on a series of patients who underwent revision total knee replacement with a Total Condylar 3 implant and metaphyseal cementing, or so-called hybrid stem fixation (Figs. 1-A and 1-B). Fig. 1-A and Fig. 1-B PFC Modular total knee prosthesis with femoral augments (Fig. 1-A) and inserts of varying constraint: PS, PS Stabilized, and TC3 (Fig. 1-B). Sixty-eight knees underwent revision total knee replacement, performed by two surgeons, between 1990 and 1998. Knees with a fully cemented stem or a liner exchange were excluded, and one patient died before the time of the two-year minimum follow-up. Forty-four revisions with use of a PFC Modular knee prosthesis (DePuy, Johnson and Johnson, Warsaw, Indiana) with a Total Condylar 3 insert and metaphyseal extension of cement were followed for an average of 5.5 years (range, two to ten years). The reasons for revision were aseptic loosening (fifteen knees), infection (seven), instability (ten), patellar dislocation (two), osteolysis (eight), and anterior knee pain (two). Clinical and radiographic analysis was performed according to Knee Society Guidelines3,4. ### Surgical Technique Following implant removal, the joint was reestablished with use …