Medial pivot-based total knee arthroplasty achieves better clinical outcomes than posterior-stabilised total knee arthroplasty

Abstract

Purpose Stability in the sagittal plane, particularly regarding anterior cruciate ligament compensation, and postoperative functionality and satisfaction remain issues in total knee arthroplasty. Therefore, this prospective study compared the clinical outcomes between medial-pivot-based and posterior-stabilised total knee arthroplasty based on anterior translation and clinical scores. Methods To assess outcomes of total knee arthroplasty for varus osteoarthritis, the anterior translation distance of the tibia relative to the femur was measured at 30 and 60° of flexion using a KS measure Arthrometer at 6 months postoperatively. The 2011 Knee Society Score, Forgotten Joint Score, visual analogue scale for pain, and range of motion were assessed at 6 months and 1 year postoperatively. The correlations among each score, anterior translation distance, range of motion, and visual analogue scale score for pain were investigated. Results The medial-pivot and posterior-stabilised groups comprised 70 and 51 patients, respectively. The medial-pivot group exhibited a significantly shorter anterior translation distance at 60° flexion than the posterior-stabilised group. Furthermore, the medial-pivot group achieved significantly better outcomes regarding the visual analogue scale for pain, 2011 Knee Society Score, and Forgotten Joint Score than the posterior-stabilised group. A significant negative correlation was observed between the anterior translation distance and the function score of the 2011 Knee Society Score, whereas a significant positive correlation was found between the anterior translation distance and flexion angle, and between the extension angle and score of the Forgotten Joint Score or 2011 Knee Society Score. Significant negative correlations were also found between the pain visual analogue scale and both the 2011 Knee Society Score and Forgotten Joint Score. Conclusion In total knee arthroplasty for osteoarthritis, the medial-pivot group displayed a shorter anterior translation distance than the posterior-stabilised group at 6 months postoperatively. The visual analogue scale score for pain was also significantly lower in the medial-pivot group than that in the posterior-stabilised group at both 6 months and 1 year postoperatively. Because a correlation was observed between the anterior translation distance and the function score, medial-pivot-based total knee arthroplasty was considered to significantly improve postoperative function compared to posterior-stabilised total knee arthroplasty.

Comparison of postoperative clinical outcome in medial‐pivotal and gradually reducing radius design cruciate‐retaining total knee arthroplasty—A multicenter analysis of propensity‐matched cohorts

“…In addition, postoperative AP laxity with the mid-flexion angle in the MP group was significantly smaller-averaging 2.2 mm-than in the CR group. Recently Kato et al described the clinical superiority of MS designs to conventional posterior-stabilized (PS) bearing [21]. They reported the MP group exhibited a significantly better FJS than the PS group.…”

“…Recently Kato et al described the clinical superiority of MS designs to conventional posterior‐stabilized (PS) bearing [ 21 ]. They reported the MP group exhibited a significantly better FJS than the PS group.…”

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

“…On the one hand, this may generate higher Forgotten Joint Scores, but on the other hand, higher forces are certainly transferred into the implant-bone or implant-cement interface. 17 , 18 There, the question of an increased loosening rate is obvious. However, recent data by Christensson et al 19 contradict this assumption: an increased migration rate when using a medial congruent insert could not be shown.…”

PCL retention demonstrates better functional scores and gait patterns in total knee arthroplasty using a medial congruent insert—a prospective study

“…The reduced lateral translation using the MC articulation offers better AP stability of the joint and less likelihood of anterolateral pain after TKA [11, 12, 24]. Ho et al demonstrated a decrease in peak pressures on the heel, medial forefoot, hallux and toes while walking up a gradient in normal individuals [10].…”