Comparisons of kinematics and range of motion in high-flexion total knee arthroplasty: cruciate retaining vs. substituting designs

Seon, Jong-Keun; Park, Ju-Kwon; Shin, Young-Joo; Seo, Hyung-Yeon; Lee, Keun-Bae; Song, Eun-Kyoo

doi:10.1007/s00167-011-1434-z

Cited by 57 publications

(57 citation statements)

References 26 publications

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“…Traditionally, it is recognised that the PS prosthesis and procedure will result in a different knee condition, including postoperative kinematics and outcomes, compared with CR [22][23][24][25]. In our study, joint-component gap at flexion was significantly larger than at extension in PS using the measured-resection technique.…”

Section: Discussionmentioning

confidence: 47%

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Matsumoto

Muratsu

Kawakami

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to prove the hypothesis that soft tissues are well balanced using the gap technique with a navigation system in cruciate-retaining (CR) and posterior-stabilised (PS) total knee arthroplasty (TKA), leading to better clinical outcomes compared with the measuredresection technique. Methods One hundred and thirty-five TKAs (90 CR and 45 PS) were performed in patients with varus-type osteoarthritis using the gap technique guided by the offset-type tensor and a navigation system. Soft-tissue balance (joint-component gap and ligament balance) were intraoperatively assessed with the tensor under 40 lb of joint-distraction force. The achievement in the equalised rectangular gap at extension and flexion was assessed and retrospectively compared with the previous series in which the measured-resection technique was used (20 CR and 100 PS TKAs). In addition, clinical outcomes, including range of motion and Knee Society Score were assessed at a minimum two year follow-up. Results In achieving equalised rectangular gaps at extension and flexion, CR TKAs met criteria in more cases [66.7 % (64/90) vs.

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Section: Discussionmentioning

confidence: 47%

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Matsumoto

Muratsu

Kawakami

et al. 2013

International Orthopaedics (SICOT)

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“…Second, the uniform use of one HF fixed-bearing prosthesis by a single surgeon suggests our findings might not be generalizable to low-volume surgeons or those using other HF prostheses such as cruciateretaining or mobile-bearing designs. Third, although the high proportion of females in our cohort is typical of Korean patients undergoing TKA [5,20,25,26,41], this also reduces the extent to which our results can be generalized. Fourth, the followup period of 4.7 years (range, 2-8 years) will not likely reflect the ultimate incidence of prosthesis-related loosening because it will almost certainly increase during further followup of our cohort, although 63% of early aseptic loosening requiring revision occurred within 2 years of followup in another study [36].…”

Section: Discussionmentioning

confidence: 90%

“…Early aseptic loosening of the femoral component reportedly occurs in 0% to 0.9% of patients at 2 to 10 years [4,10,27,29,44,48] in conventional TKA, and concerns have therefore been raised about the high incidence of early aseptic loosening in HF designs [7,17]. However, a number of clinical studies reporting 25 to 259 knees [3,8,20,[24][25][26] have suggested conflicting findings with only a few instances of prosthesis-related failures after HF TKA at mean followups of 12 to 51 months even in the same ethnic group [5,20,[24][25][26]41]. The risk of early aseptic loosening after HF TKA in large cohort studies is unclear.…”

Section: Introductionmentioning

confidence: 99%

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Lee

Chung²,

Kim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses.Questions/purposes We therefore determined (1) the rate of achieving postoperative HF after HF TKA; (2) whether the aseptic loosening rate of HF prostheses is high; and (3) whether the survivorship was worsened in patients who achieved postoperative deep knee flexion in our cohort of Korean patients. Methods We retrospectively reviewed 488 patients who had 698 primary TKAs using the NexGen 1 Legacy Posterior-Stabilized Flex system implanted from 2003 to 2010. There were 40 men and 448 women with a mean age of 68 years. We obtained Hospital for Special Surgery scores, maximal flexion, and radiographs. The minimum followup for functional and radiographic evaluations was 2 years (median, 4.8 years; range, 2-8.7 years). We performed a survival analysis on all patients for aseptic loosening. Results Three hundred sixty knees (52%) could achieve C 135°maximum flexion. Six of the 698 knees (0.9%) developed aseptic loosening (three femoral and three tibial). The survival at 5 years for aseptic loosening was 99.1%. The overall survival for aseptic failure did not differ between knees that achieved HF and those that did not.

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“…Kim et al [11] in 2009, in a prospective randomized study (minimum follow-up of 2 years), compared high-flexion posteriorretained with high-flexion posterior-stabilized prosthesis and also did not notice a difference in range of knee motion, clinical and radiographic results. However, in 2011, Seon et al [12] published another prospective randomized study which also compared high-flexion posterior-stabilized TKA with high-flexion posterior-retained TKA and disagreed: the former prosthesis proved superior to the latter in weight-bearing maximum flexion and posterior femoral roll-back, although no difference was noted in clinical outcomes. Yagishita et al [13] performed a prospective randomized study in 2012, with a minimum followup of 5 years, which indicated that posterior-stabilized prosthesis showed better results in postoperative knee motion, posterior knee pain at passive flexion and patient satisfaction, but no significant difference was found between the 2 types of TKA regarding Knee Society Score.…”

Section: Retaining Tkamentioning

confidence: 99%

“…Yagishita et al [13] Prospective, randomized study comparing high-flexion CR design implanted in one knee and high-flexion PS design implanted in the other knee in simultaneous bilateral TKA PS prosthesis better in postoperative knee motion, posterior knee pain at passive flexion and patient satisfaction Seon et al [12] Prospective randomized trial, comparing in vivo kinematics, range of motion, and functional outcomes in patients who received either a highflexion cruciate retaining or a high-flexion cruciate substituting TKR No differences in clinical outcomes. PS TKR superior to CR TKR in weight-bearing maximum flexion and posterior femoral roll-back Kim et al [11] Prospective randomized trial, comparing ROM and functional outcome in knees receiving either a high-flexion posterior cruciate-retaining or a highflexion posterior cruciate-substituting TKR…”

Section: No Differences Between the 2 Designsmentioning

confidence: 99%

Common controversies in total knee replacement surgery: Current evidence

Nikolaou¹

2014

WJO

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Total knee replacement (TKR) is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following total knee arthroplasty, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery. Posterior-stabilized or cruciate-retaining prosthesis? To use a tourniquet during operation or not? Do patients need continuous passive motion for their post-surgery rehabilitation? To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and more well conducted high quality trials are needed in order to gain more secure answers. At the same time, it is becoming apparent that a meticulous operative technique, respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing, are some of the parameters that might contribute more to achieving the optimal results for the patients. Key words: Total knee replacement; Controversy; Literature review; Patella resurfacing; Patella eversion; Posterior stabilized; Cruciate retaining; Tourniquet; Continuous passive motion Core tip: A literature review has been conducted in an effort to present the best available evidence of the last decade and to shed light on some of the most controversial subjects related to total knee replacement surgery. Patella resurfacing or not? Posterior cruciate retaining or sacrificing? Continuous passive motion or not? Tourniquet or not? These are some of the most debatable topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and better conducted high quality trials are needed in order to gain more secure answers.Nikolaou VS, Chytas D, Babis GC. Common controversies in total knee replacement surgery: Current evidence. World J Orthop 2014; 5(4

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Comparisons of kinematics and range of motion in high-flexion total knee arthroplasty: cruciate retaining vs. substituting designs

Abstract: PS high-flexion TKA provided greater weight-bearing maximal flexion and posterior femoral roll-back than CR high-flexion TKA, although no difference in clinical outcomes was observed between the two prosthesis designs.

Cited by 57 publications

References 26 publications

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Common controversies in total knee replacement surgery: Current evidence

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