(1) Background: Total knee arthroplasty (TKA) is a well-established surgical treatment for end-stage osteoarthritis. While no leading factor can be identified, the high frequency of patient dissatisfaction (20%) pertains to several key features such as preoperative expectations and postoperative improvement in knee function. Bicruciate-retaining total knee arthroplasty (BCR-TKA) may improve kinematics and lead to improved clinical outcome in the higher-demanding patients. (2) Methods: A systematic review of the literature was performed to assess the best available preclinical and clinical literature on BCR-TKA for kinematics and clinical outcome and adverse events such as implant loosening. Articles were screened using predefined in- and exclusion criteria. The guidelines for Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used. (3) Results: The literature search resulted in 352 articles which were screened for title and abstract. After application of the in- and exclusion criteria, 13 preclinical and 30 clinical articles were included. The methodological quality of studies was low, including mainly level IV studies. (4) Conclusions: This is the first report that provides a systematic description of the broad available preclinical and clinical literature on BCR-TKA. It underlines the current interest in improving kinematics and clinical outcome based on a more anatomical TKA design. The current review demonstrates the low methodological quality of clinical trials that have investigated BCR-TKA. Currently, there are insufficient data to support broad (“state of the art”) implantation of BCR-TKA. Preclinical and clinical research suggest, however, that the design has a potential benefit to achieve improved kinematics in the young and active arthroplasty patient and warrants future research for new-generation designs with optimal (tibial) fixation and reproducible (robot or navigated) surgical placement.

Pelvic discontinuity (PD) is a detrimental complication following total hip arthroplasty (THA). The aim of this study was to assess the clinical and radiological results of patients with PD who were revised using a custom-made triflange acetabular component (CTAC).This is a single centre prospective study of patients with PD following THA who were treated with a CTAC. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Clinical and radiological complications, including reasons for revisions were registered. Trends over time are described and tested for significance and clinical relevance.18 females with 22 CTACs were included with a mean age of 73.5 years (SD 7.7). There were significant improvements between baseline and final follow-up in HOOS (p<0.01), mOHS (p<0.01), EQ-5D-3L utility (p<0.01), EQ-5D-3L NRS (p<0.01), VAS pain rest (p<0.01), and VAS pain activity (p<0.01). A minimal clinically important improvement in mOHS and the HOOS was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage.This is the first prospective assessment in clinical outcome of patients with PD who were treated with a CTAC. We have demonstrated that CTAC in patients with THA acetabular loosening and PD can result in stable constructs with no mechanical failures. Moreover, clinically relevant improvements in health-related quality of life at two years’ follow-up was observed.