Higher Frequency of Reoperation With a New Bicruciate-retaining Total Knee Arthroplasty

Abstract

Background With as many as 25% of patients reporting residual knee symptoms after primary total knee arthroplasty (TKA), alternative implant designs and surgical techniques have been proposed to further reduce these symptoms. There is growing evidence that retention of the anterior cruciate ligament (ACL) results in more natural knee kinematics; thus, implants with more normal joint mechanics could provide improved physical function postoperatively and reduce the amount of residual symptoms. Advancements in the bicruciate-retaining (BCR) TKA implant design have been made, and based on these, we wished to compare the BCR with a more traditional cruciate-retaining (CR) implant. Questions/purposes (1) Was there a difference in the risk of reoperation after primary TKA between BCR and CR implant designs? (2) Was there a difference in the radiographic findings of radiolucent lines (RLLs) between the implant designs? (3) Was there a difference in patient-reported and clinical outcomes between the two implant designs? Methods Between January 2013 and May 2014, two surgeons performed 475 primary TKAs. During this time, 78 (16%) of these were performed with BCR implants and 294 (62%) with CR implants; the remainder were performed with anterior-stabilized or more constrained designs as a result of increased deformity and/or ligamentous deficiencies. During this period, the general indications for BCR TKA were arthritic knees with only slight to moderate deformity and sufficient ligamentous integrity of both the ACL and posterior cruciate ligament. The indications for CR TKA were similar other than these patients presented with a deficient ACL. A total of 66 (85%) of the BCR and 237 (81%) of the CR TKAs were available for followup at a minimum of 12 months or when reoperation occurred before 12 months (mean, 18 months; range, 2-32 months). With the numbers available, there were no differences between the groups in terms of age and sex, but the patients undergoing CR TKA had a greater mean body mass index (33 ± 7 versus 31 ± 5 kg/m 2 , p = 0.032). The frequency of early reoperation was compared between the groups as were radiographic evidence of RLL, patient-reported outcomes, and knee range of motion (ROM).

The influence of polyethylene bearing thickness on the tibiofemoral kinematics of a bicruciate retaining total knee arthroplasty

“…Similar findings were noted by Pritchett, who reported a 23 year survivorship of 89% in 489 BCR TKAs, with only four revisions of the femoral and tibial components [6]. In contrast, Christensen et al reported higher frequency of revision and increased radiolucent lines under the tibial tray for BCR compared to a conventional cruciate-retaining TKA [41]. However, as noted by the study's authors, the mean follow-up time was short (1.29 years), the sample size was small (n = 66), and initial learning curve experience could have influenced the results.…”

Bi‐Cruciate Retaining Total Knee Arthroplasty Does Not Restore Native Tibiofemoral Articular Contact Kinematics During Gait

“…Similarly, reduced medial condyle lowest point posterior translation and notable opposing internal rotation motion trends in BCR TKA during most of the stance phase were found when compared to the data reported for PS TK . In a recent study comparing the same BCR TKA design used in our study against CR TKA, Christensen et al reported longer mean surgical durations for BCR TKA and a higher frequency of all‐cause revision, reoperation and radiolucent lines at a mean of 18 months. In addition, there were no differences in patient reported clinical outcomes between the BCR and CR TKA groups.…”

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

“…Moreover, a previous study reported that the BCR implant has inferior survivorship and concerning radiographic findings when compared with a conventional cruciate retaining (CR) implant with respect to complications after primary TKA. 10 However, there were no differences in patient-reported clinical outcomes (PROM) between the BCR and CR TKA groups. Component misalignment has been suggested as one important factor associated with accelerated wear, poor functional outcomes, and increased revision rates in contemporary TKA designs, 11,12 thus precise component alignment may be important for the optimization of patient reported clinical outcomes in BCR TKA.…”