A prospective comparison of total knee arthroplasty using ultra-congruent, condylar-stabilizing, and posterior-stabilized devices implanted with kinematic alignment: better 2-year outcomes with ultra-congruent

Carlson, Brian J.; Jones, Brett K; Scott, David F.

doi:10.1007/s00167-022-07206-w

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…The functional analysis revealed no differences between the two implants for FJS, ROM and KSS Function scores, with only the KSS Knee score being significantly better in the CS group. These results are consistent with previous studies conducted over the past decade, showing no functional differences between CS and PS implants [5, 6]. However, CS implants showed a tendency to have higher functional outcomes.…”

Section: Discussionsupporting

confidence: 93%

“…Nevertheless, the literature is inconclusive as to the best implant for restoring native knee kinematics, in particular for CS implants. Few studies have compared functional outcomes and the revisions rate of CS vs. PS TKA [5]. And no study assessed the gait parameters of CS implants with PCL sacrifice.…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have suggested that the new CS design achieved good functional outcomes, similar to PS prostheses [5]. This CS design also prevents additional bone resection, condylar fracture, and patellar clunk syndrome due to the absence of a PS box [23].…”

Section: Introductionmentioning

confidence: 99%

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Cruciate‐substituting and posterior‐stabilised total knee arthroplasties had similar gait patterns in the short term

Favroul,

Batailler,

Naaim

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Surgeons want to achieve native kinematics in primary total knee arthroplasty (TKA). Cruciate-substituting (CS) implants could restore the knee kinematics more efficiently than posterior-stabilised (PS) TKA. This study aimed to compare gait patterns in patients with CS or PS TKA at 6 months. The hypothesis was that CS implants would demonstrate comparable gait parameters to PS implants at 6 months. Methods In this prospective case-control study, 38 primary TKA without coronal laxity were divided into 2 groups: 19 cruciate-substituting (CS) and 19 posterior-stabilised (PS) implants. The type of prosthesis was determined according to the surgical period. Exclusion criteria were TKA revision, associated procedures and inability to walk on a treadmill. Gait analysis was conducted on a treadmill 6 months postoperatively for each patient with a knee assessment device (KneeKG®). Gait characteristics included analysis in three spatial dimensions (flexion-extension, abduction-adduction, internal-external rotation, anterior-posterior translation). Clinical outcomes (Knee Society Score and Forgotten Joint Score) were compared between both groups at 6 months postoperatively. Results At 6 months, the gait analysis did not demonstrate any significant difference between CS and PS implants. The range and the maximum anteroposterior translation were similar in both groups (9.2 ± 6.5 mm in CS group vs. 8.1 ± 3 mm in PS group (n.s.); and − 5.2 ± 5 mm in CS group vs. − 6.3 ± 5.9 mm in PS group (n.s.), respectively). The internal/external rotation, the flexion, and the varus angle were similar between CS and PS implants. The KSS Knee score was higher at 6 months in the CS group than in the PS group (92.1 ± 5.6 vs. 84.8 ± 8.9 (p < 0.01)). Conclusion Cruciate-substituting and posterior-stabilised TKA had similar gait patterns at 6 months postoperatively, despite a non-equivalent posterior stabilisation system. CS prostheses were an interesting option for primary TKA for knee kinematics restoration without requiring a femoral box. Level of evidence Prospective, case-control study; Level II.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Cruciate‐substituting and posterior‐stabilised total knee arthroplasties had similar gait patterns in the short term

Favroul,

Batailler,

Naaim

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…[16,18] UCFB designs have been found to have fewer overall radiolucent lines compared to other TKA designs. [25,27] One possible explanation for this nding is that the increased surface area of contact redistributes the contact stress between the tibial insert and the femoral component in UC design. This increased contact area leads to improved stability and less wear/tear on the components.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Congruent Tibial Inserts in Total Knee Arthroplasty: A Network Meta- analysis of Randomized Controlled Trials

Tsai

Lin

et al. 2023

Preprint

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Objective This study aims to determine whether modern ultracongruent tibial inserts are associated with different outcomes in Total Knee Arthroplasty (TKA). Background Ultracongruent fixed-bearing (UCFB) and medial congruent fixed-bearing (MCFB) inserts have been known to be effective in total knee arthroplasty with patient satisfaction. Nonetheless, no supporting evidence to date exists to rank the clinical outcomes of these various congruent inserts in TKA. Methods We searched for PubMed, Embase, The Cochrane Central Register of Controlled Trials, Web of Science, and Scopus up to May 15, 2022. We selected studies involving an active comparison of UCFB or MCFB in TKAs. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared different congruent inserts. We ranked the clinical outcomes by SUCRA score with the estimate of the best treatment probability. Our primary outcomes were revision rates and radiolucent lines. Secondary outcomes were functional scores, including the range of motion (ROM), the Knee Society Score (KSS), Oxford Knee Score (OKS), and WOMAC. Results 18 RCTs with 1793 participants were obtained. The MCFB performed similar revision rates as CRFB and PSRP. CRFB and UCFB had the lowest radiolucent lines. UCFB and MCFB had the best OKS score overall. Conclusions The ranking probability for better clinical outcomes in congruent inserts demonstrated the superiority of congruent tibial inserts, including UCFB and MCFB. UCFB may be associated with improved postoperative functional outcomes. However, integrating future RCTs for high-level evidence is necessary to confirm these findings.

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“…The results of our analysis indicate that UC designs provide fewer radiolucent lines. Additionally, our analysis showed that congruent inserts may lead to improved functional scores, such as the Oxford Knee Score and WOMAC [ 25 , 38 ]. These findings may be attributed to the higher anterior lip exactly controlling posterior translation of the tibia in flexion after sacrificing PCL requiring posterior stability.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Congruent Tibial Inserts in Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials

Tsai,

Lin

et al. 2023

Life

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Objective: The aim of this study was to determine whether modern congruent tibial inserts are associated with superior outcomes in total knee arthroplasty (TKA). Background: Ultracongruent fixed-bearing (UCFB) and medial congruent fixed-bearing (MCFB) inserts have been known to be effective in total knee arthroplasty with patient satisfaction. Nonetheless, no supporting evidence to date exists to rank the clinical outcomes of these various congruent inserts in TKA compared with other important considerations in TKA including cruciate-retaining fixed-bearing (CRFB) and posterior-stabilized fixed-bearing (PSFB) inserts. Methods: We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus up to 15 May 2022. We selected studies involving an active comparison of UCFB or MCFB in TKAs. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared different congruent inserts. We ranked the clinical outcomes by SUCRA score with the estimate of the best treatment probability. Our primary outcomes were revision rates and radiolucent lines. Secondary outcomes were functional scores, including the range of motion (ROM), the Knee Society Score (KSS), the Oxford Knee Score (OKS), and WOMAC. Results: Eighteen RCTs with 1793 participants were analyzed. Our NMA ranked MCFB, CRFB, and UCFB with the lowest revision rates. CRFB and UCFB had the fewest radiolucent lines. UCFB had overall the best ROM. UCFB and MCFB had the best OKS score overall. Conclusions: The ranking probability for better clinical outcomes in congruent inserts demonstrated the superiority of congruent tibial inserts, including UCFB and MCFB. UCFB may be associated with better ROM and postoperative functional outcomes. However, integrating future RCTs for high-level evidence is necessary to confirm these findings.

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A prospective comparison of total knee arthroplasty using ultra-congruent, condylar-stabilizing, and posterior-stabilized devices implanted with kinematic alignment: better 2-year outcomes with ultra-congruent

Cited by 7 publications

References 33 publications

Cruciate‐substituting and posterior‐stabilised total knee arthroplasties had similar gait patterns in the short term

Cruciate‐substituting and posterior‐stabilised total knee arthroplasties had similar gait patterns in the short term

The Effect of Congruent Tibial Inserts in Total Knee Arthroplasty: A Network Meta- analysis of Randomized Controlled Trials

The Effect of Congruent Tibial Inserts in Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials

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