Functional Outcomes of a New Mobile-Bearing Ultra-Congruent TKA System: Comparison With the Posterior Stabilized System

Machhindra, Morey Vivek; Kang, Jung Mook; Kang, Yeon June; Chowdhry, Madhav; Kim, Tae Kyun

doi:10.1016/j.arth.2015.06.011

Cited by 28 publications

(21 citation statements)

References 41 publications

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“…UC design has an increased anterior buildup and a more conforming articular surface to prevent anterior displacement during knee flexion and provides an easy option to substitute the PCL without additional bone resection. 6 Many studies have compared the results between UC and the other implant types-some studies compared mobile-bearing UC and PS design, 7,8 some other studies compared fixed-bearing UC implant and cruciate-retaining design, 9,10 and other previous studies compared between fixed-bearing UC and PS design in respect of intraoperative condition [11][12][13] -the results have been controversial. Few studies compared between fixed-bearing UC and PS design in terms of range of motion (ROM), stability, and clinical outcomes; moreover, these studies are too short-term follow-up study or small volume study.…”

Section: Introductionmentioning

confidence: 99%

Similar outcomes between ultracongruent and posterior-stabilized insert in total knee arthroplasty: A propensity score-matched analysis

Lee

Yeom

Lee

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: (1) To compare postoperative range of motion (ROM), stability, and clinical outcomes between fixed-bearing posterior-stabilized (PS) and ultracongruent (UC). (2) The effect of postoperative stability on ROM and clinical outcomes was also evaluated in both designs. Materials and methods: Propensity score matching was conducted for age, gender, body mass index, preoperative ROM, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Knee Society (KS) scores, hip–knee–ankle (HKA) alignment, and follow-up period. Two hundred patients (100 PS and 100 UC) were enrolled. Preoperative and final follow-up outcomes including postoperative ROM, anteroposterior (AP) stability (good, fair, and poor), WOMAC index, and KS scores were compared. Then, postoperative outcomes compared between the PS and UC. We also analyzed if AP stability was associated with the postoperative outcomes in both implant designs. Results: In both groups, ROM and clinical outcomes of final follow-up showed improvement than preoperation. Statistical significance was not determined between the PS and UC groups in terms of postoperative ROM (PS vs. UC, 134.6° vs. 133.4°, p = 0.13), stability (good/fair/poor, 91/9/0 vs. 84/14/0, p = 0.376), WOMAC index, KS scores, and outliers of HKA alignment (15% vs. 10%, p = 0.393). “Fair” stability showed inferior KS scores but greater ROM than “good” stability in both designs. Conclusion: TKA with UC insert provided similar ROM, AP stability, and clinical outcomes when compared to PS insert. In both designs, greater postoperative ROM was found but inferior clinical outcomes were found when TKA resulted in fair stability instead of good stability. Level of evidence III: Retrospective comparative study.

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Section: Introductionmentioning

confidence: 99%

No kinematical difference between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment: an in vivo dynamic RSA study

Alesi

Paolo

Bragonzoni

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To explore in vivo kinematical behavior of the same total knee arthroplasty (TKA) cruciate-retaining (CR) femoral design with either medial-congruent (MC) or ultra-congruent (UC) inlay using model-based dynamic radiostereometric analysis (RSA). The hypothesis was that there would be comparable kinematics between the two groups. Methods A cohort of 16 randomly selected patients (8 MC Persona Zimmer, 8 UC Persona Zimmer) was evaluated through dynamic radiostereometric analysis (RSA) at a minimum of 9 months after TKA, during the execution of a sit-to-stand. The antero-posterior (AP) translation of the femoral component and the AP translation of the low point of medial and lateral femoral compartments were compared through Student’s t test (p < 0.05). Results Both groups showed a medial pivot behavior, with a significantly greater anterior translation of the Low Point of the lateral compartment with respect to the medial compartment (MC medial range: 2.4 ± 2.4 mm; MC lateral range: 7.7 ± 3.0 mm; p < 0.001 – UC medial range: 3.3 ± 3.3 mm; UC lateral range: 8.0 ± 3.2 mm; p < 0.001). A statistically significant greater degree of flexion was clinically recorded at follow-up visit in the MC group respect to the UC group (126° vs 101°—p = 0.003). Conclusion The present study did not show difference in the medial pivot behavior between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment; however, the MC group demonstrated a greater degree of flexion. The MC design examined is a valid alternative to the UC design, allowing to achieve a screw-home movement restoration combined with a high flexion. Level of evidence IV.

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“…One study has compared a mobile bearing CS design to a fixed bearing PS prosthesis for primary TKA and found similar ROM between groups to the present study [ 29 ]. Two studies have previously reported outcomes comparing two mobile bearing designs (CS versus PS) [ 21 ], with one reporting reduced range of motion using the CS compared to mobile-bearing PS TKAs (126° vs. 131°) [ 34 ]. The findings of the current study did not demonstrate clinically meaningful differences in ROM and indeed outcomes post TKA may be related to additional factors such as balancing [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Similar outcomes including maximum knee flexion between mobile bearing condylar-stabilised and fixed bearing posterior-stabilised prosthesis: a case control study

et al. 2022

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Purpose Prosthesis design influences stability in total knee arthroplasty and may affect maximum knee flexion. Posterior-stabilised (PS) and condylar-stabilised (CS) designed prosthesis do not require a posterior-cruciate ligament to provide stability. The aim of the current study was to compare the range of motion (ROM) and clinical outcomes of patients undergoing cemented total knee arthroplasty (TKA) using either a PS or CS design prosthesis. Methods A total of 167 consecutive primary TKAs with a CS bearing (mobile deep-dish polyethylene) were retrospectively identified and compared to 332 primary TKA with a PS constraint, with similar design components from the same manufacturer. Passive ROM was assessed at last follow-up with use of a handheld goniometer. Clinical scores were assessed using Patient-Reported Outcome Measures (PROMs); International Knee Society (IKS) knee and function scores and satisfaction score. Radiographic assessment was performed pre and post operatively consisting of mechanical femorotibial angle (mFTA), femoral and tibial mechanical angles measured medially (FMA and TMA, respectively) on long leg radiographs, tibial slope and patella height as measured by the Blackburne-Peel index (BPI). Results Both groups had a mean follow-up of 3 years (range 2–3.7 years). Mean post-operative maximum knee flexion was 117° ± 4.9° in the PS group and 119° ± 5.2° in the CS group (p = 0.29). Postoperative IKS scores were significantly improved in both groups compared to preoperative scores (p < 0.01). The mean IKS score in the PS group was 170.9 ± 24.1 compared to 170.3 ± 22.5 in the CS group (p = 0.3). Both groups had similar radiographic outcomes as determined by coronal and sagittal alignment, tibial slope and posterior condylar offset ratio measurements. When considering the size of tibial slope change and posterior-condylar offset ratio, there was no differences between groups (p = 0.4 and 0.59 respectively). The PS group had more interventions for post-operative stiffness (arthrolysis or manipulation under anaesthesia) 8 (2.7%) compared to 1 (0.6%) in the CS group (p = 0.17). Conclusion Condylar-stabilised TKA have similar patient outcomes and ROM at a mean follow-up of 3 years compared to PS TKA. Highly congruent inserts could be used without compromising results in TKA at short term. Level of evidence Level IV, retrospective case control study.

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Functional Outcomes of a New Mobile-Bearing Ultra-Congruent TKA System: Comparison With the Posterior Stabilized System

Cited by 28 publications

References 41 publications

Similar outcomes between ultracongruent and posterior-stabilized insert in total knee arthroplasty: A propensity score-matched analysis

Similar outcomes between ultracongruent and posterior-stabilized insert in total knee arthroplasty: A propensity score-matched analysis

No kinematical difference between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment: an in vivo dynamic RSA study

Similar outcomes including maximum knee flexion between mobile bearing condylar-stabilised and fixed bearing posterior-stabilised prosthesis: a case control study

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