Comparison of Cruciate-Sacrificing vs Posterior-Stabilized Total Knee Replacement Using a Contemporary Total Knee System

Bernasek, Thomas L.; Stoops, T. Kyle; Gill, Meera; Engel, Corey; Simon, Péter

doi:10.1016/j.arth.2021.08.029

Cited by 7 publications

(4 citation statements)

References 17 publications

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“… 23) As the average patient weight or weight-bearing demand increases, there is a concern that the pressures across the patellofemoral joint may reach threshold values for pain as well as possible patella component fracture. Other clinical studies have shown that there are no significant differences in functional or patient satisfaction scores between CR and PS total knee implants, 24 25 26) yet this study demonstrated that extreme weight-bearing across the patellofemoral joint illuminates certain implant differences. This is a clinically relevant finding as we believe the PS implant design may not be best suited for individuals with high weight-bearing demands due to the heightened contact area and the contact force in the patellofemoral joint.…”

Section: Discussionmentioning

confidence: 49%

Load-Dependent Characteristics of Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Biomechanical Study

Lee,

Schwarzkopf,

Fraipont

et al. 2024

Clin Orthop Surg

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Background Increased load bearing across the patellofemoral and tibiofemoral articulations has been associated with total knee arthroplasty (TKA) complications. Therefore, the purpose of this study was to quantify the biomechanical characteristics of the patellofemoral and tibiofemoral joints and simulate varying weight-bearing demands after posterior cruciate ligament-retaining (CR) and posterior-stabilized (PS) TKAs. Methods Eight fresh-frozen cadaveric knees (average age, 68.4 years; range, 40–86 years) were tested using a custom knee system with muscle-loading capabilities. The TKA knees were tested with a CR and then a PS TKA implant and were loaded at 6 different flexion angles from 15° to 90° with progressively increasing loads. The independent variables were the implant types (CR and PS TKA), progressively increased loading, and knee flexion angle (KFA). The dependent variables were the patellofemoral and tibiofemoral kinematics and contact characteristics. Results The results showed that at higher KFAs, the position of the femur translated significantly more posterior in CR implants than in PS implants (36.6 ± 5.2 mm and 32.5 ± 5.7 mm, respectively). The patellofemoral contact force and contact area were significantly greater in PS than in CR implants at higher KFAs and loads (102.4 ± 12.5 N and 88.1 ± 10.9 N, respectively). Lastly, the tibiofemoral contact force was significantly greater in the CR than the PS implant at flexion angles of 45°, 60°, 75°, and 90° KFA, the average at these flexion angles for all loads tested being 246.1 ± 42.1 N and 192.8 ± 54.8 N for CR and PS implants, respectively. Conclusions In this biomechanical study, CR TKAs showed less patellofemoral contact force, but more tibiofemoral contact force than PS TKAs. For higher loads across the joint and at increased flexion angles, there was significantly more posterior femur translation in the CR design with a preserved posterior cruciate ligament and therefore significantly less patellofemoral contact area and force than in the PS design. The different effects of loading on implants are an important consideration for physicians as patients with higher load demands should consider the significantly greater patellofemoral contact force and area of the PS over the CR design.

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Section: Discussionmentioning

confidence: 49%

Load-Dependent Characteristics of Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Biomechanical Study

Lee,

Schwarzkopf,

Fraipont

et al. 2024

Clin Orthop Surg

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“…Some surgeons use the UC insert as their standard insert and routinely resect the posterior cruciate ligament (PCL) in a cruciate-sacrificing (CS) procedure. 10 The rationale for this surgical technique is that the stability is obtained via the conformity of the UC insert. More recently, a polyethylene insert was designed with a more constrained medial and less constrained lateral geometry (medial congruent (MC) insert).…”

Section: Introductionmentioning

confidence: 99%

Tibial insert design significantly alters knee kinematics using a single cruciate-retaining total knee implant

Faschingbauer,

Hambrecht,

Schwer

et al. 2024

Bone Jt Open

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AimsPatient dissatisfaction is not uncommon following primary total knee arthroplasty. One proposed method to alleviate this is by improving knee kinematics. Therefore, we aimed to answer the following research question: are there significant differences in knee kinematics based on the design of the tibial insert (cruciate-retaining (CR), ultra-congruent (UC), or medial congruent (MC))?MethodsOverall, 15 cadaveric knee joints were examined with a CR implant with three different tibial inserts (CR, UC, and MC) using an established knee joint simulator. The effects on coronal alignment, medial and lateral femoral roll back, femorotibial rotation, bony rotations (femur, tibia, and patella), and patellofemoral length ratios were determined.ResultsNo statistically significant differences were found regarding coronal alignment (p = 0.087 to p = 0.832). The medial congruent insert demonstrated restricted femoral roll back (mean medial 37.57 mm; lateral 36.34 mm), while the CR insert demonstrated the greatest roll back (medial 42.21 mm; lateral 37.88 mm; p < 0.001, respectively). Femorotibial rotation was greatest with the CR insert with 2.45° (SD 4.75°), then the UC insert with 1.31° (SD 4.15°; p < 0.001), and lowest with the medial congruent insert with 0.8° (SD 4.24°; p < 0.001). The most pronounced patella shift, but lowest patellar rotation, was noted with the CR insert.ConclusionThe MC insert demonstrated the highest level of constraint of these inserts. Femoral roll back, femorotibial rotation, and single bony rotations were lowest with the MC insert. The patella showed less shifting with the MC insert, but there was significantly increased rotation. While the medial congruent insert was found to have highest constraint, it remains uncertain if this implant recreates native knee kinematics or if this will result in improved patient satisfaction.Cite this article: Bone Jt Open 2024;5(7):592–600.

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“…Total hip arthroplasty (THA) significantly changed the treatment of patients handicapped by arthritis in the 1960s, producing favorable long-term results and thus becoming one of the most successful orthopedic surgical interventions [ 1 ] and one of the top five most common and fastest-growing procedures [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite being a successful procedure, THA puts a lot of strain on individuals and national healthcare systems; as a result, the importance of health technology assessment for medical devices will grow in terms of dependability and quality control [ 2 ]. In this context, bioengineering advances have contributed to the development of hip prostheses, better materials, and designs that give a greater range of motion while also improving stability and reducing friction [ 1 ]. Along with the improvement of biomaterials used in THA, computer-assisted surgery is expected to provide contributions in comparison to classical THA surgery, having advantages such as precise implant placement and decreasing complication rates, with minimally invasive surgery reducing soft-tissue injury and allowing for faster discharge and recuperation [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Updates on Biomaterials Used in Total Hip Arthroplasty (THA)

et al. 2023

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One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient’s quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.

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Comparison of Cruciate-Sacrificing vs Posterior-Stabilized Total Knee Replacement Using a Contemporary Total Knee System

Cited by 7 publications

References 17 publications

Load-Dependent Characteristics of Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Biomechanical Study

Load-Dependent Characteristics of Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Biomechanical Study

Tibial insert design significantly alters knee kinematics using a single cruciate-retaining total knee implant

Updates on Biomaterials Used in Total Hip Arthroplasty (THA)

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