Posterior-stabilized inserts are preferable to cruciate-substituting ultracongruent inserts due to more favourable kinematics and stability

Bae, Ji Hoon; Yoon, Jung Hwan; Sung, Ju Hyoung; Shin, Yang Sik

doi:10.1007/s00167-018-4872-z

Cited by 32 publications

(32 citation statements)

References 35 publications

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“…Despite the kinematic differences, studies have found equivalent clinical outcomes between PS TKA and UC inserts. 47,49,50,55,56 Some studies have also shown that UC inserts have comparable clinical outcomes to cruciate retaining TKA. 54,57–59…”

Section: Ultracongruent Insertsmentioning

confidence: 99%

Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty

Bloch

James

2019

EFORT Open Reviews

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Multi radius (MR) total knee arthroplasty (TKA) has been associated with mid-flexion instability. Single radius (SR) TKA may provide better anteroposterior stability through single flexion axis and biomechanical advantage for quadriceps function. Medial pivot (MP) TKA and gradually reducing (GR) radius TKA produce better knee kinematics. Clinical outcomes are equivalent for SR, MR and MP TKA. Short-term studies have shown better clinical outcomes and kinematics for GR TKA. Thinner and narrow anterior flange, deeper trochlea groove and more anatomical trochlea design reduces patellofemoral complications in TKA Ultracongruent inserts provide comparable clinical outcomes to posterior-stabilized TKA and cruciate retaining TKA.Cite this article: EFORT Open Rev 2019;4:519-524. DOI: 10.1302/2058-5241.4.180083

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Section: Ultracongruent Insertsmentioning

confidence: 99%

Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty

Bloch

James

2019

EFORT Open Reviews

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“…One previous cadaver study compared the biomechanics of intact, CR and CS TKR during simulated stair‐descent loading, and noted a substantial anterior femoral shift of the CS TKR knees (without a PCL), which agrees with the current study. Generally speaking, however, most clinical studies have found that there is little to no difference in the clinical outcomes of CR bearings with a PCL versus CS (or ultra‐congruent) bearings without a PCL . The fact that findings from in vitro cadaver studies do not seem to present clinically in the form of any functional disability may be due to simplifications and abstractions from the real loading scenario; or, on the clinical side, insensitivity to relatively small changes in joint laxity or post‐operative muscle compensation to stabilize the knee.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, biomedical device manufacturers have offered increased‐stability implants for patients with cruciate ligamentous deficiency, which employ more congruent condylar surfaces rather than a traditional cam‐post mechanism, referred to by some as “Ultracongruent” (Zimmer‐Biomet, Aesculap), “Deep Dished” (Smith and Nephew), or “Condylar‐Stabilized” (Stryker). Previous studies disagree on the efficacy of these bearing designs, especially in regards to their ability to provide normal knee stability …”

mentioning

confidence: 99%

“…Previous studies disagree on the efficacy of these bearing designs, especially in regards to their ability to provide normal knee stability. [5][6][7][8] Instability remains a leading cause for TKR revision surgery, 9 suggesting that long-established standardized testing protocols for pre-clinical testing of TKR 10 are not fully effective. Therefore, in vitro neutral motion and laxity/stability testing of TKR with surrounding ligaments has emerged as a useful alternative, especially considering that different bearings are optimized for different ligament conditions.…”

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confidence: 99%

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Condylar‐Stabilized TKR May Not Fully Compensate for PCL‐Deficiency: An In Vitro Cadaver Study

Willing

Moslemian

Yamomo

et al. 2019

Journal Orthopaedic Research

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Increased‐congruency bearing options are widely available in numerous total knee replacement (TKR) systems, with the intended purpose of compensating for posterior‐cruciate ligament (PCL) deficiency. However, their ability to provide adequate stability in this setting has been debated. This in vitro joint simulator study measured changes in knee joint kinematics and stability during passive flexion–extension motions and simulated activities of daily living resulting from TKR with condylar‐stabilized (CS) TKR without a PCL versus cruciate‐retaining (CR) TKR. During passive flexion, the CS TKR resulted in a more posterior tibial positioning than both the intact joint and CR TKR (by 3.4 ± 1.0 mm and 4.8 ± 0.7 mm, respectively). With a posterior tibial force applied, the CS TKR tibia was again significantly more posterior than that of the intact joint and CR TKR (by 4.7 ± 1.3 mm and 5.6 ± 0.8 mm, respectively). Furthermore, there were significant differences in the anterior/posterior kinematics of both TKR with respect to intact knees during gait, and differences between the CS and CR TKR during stair ascent and descent. Overall, there appears to be a reduction in anterior–posterior stability of the PCL‐deficient CS TKR knee, suggesting that contemporary increased‐congruency bearing surface designs may not adequately compensate for the loss of the PCL. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2172–2181, 2019

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“…High quality studies have scores of 4–8, whereas low quality studies have scores of 0–3. [ 17 ] For the Newcastle-Ottawa Scale, as recommended by the Cochrane Non-Randomized Studies Methods Working Group, we assessed studies based on 3 criteria: selection of the study groups, comparability of the groups, and ascertainment of either the exposure or the outcome of interest for case-control and cohort studies. The maximum score observed was 9 points, and total scores lower than 4 points were considered low in quality.…”

Section: Methodsmentioning

confidence: 99%

Comparison of stemless and conventional stemmed shoulder arthroplasties in shoulder arthropathy

2021

Self Cite

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Background: It is unclear whether stemless shoulder prosthesis lead to better clinical outcomes than conventional stemmed shoulder prosthesis. The purpose is to compare clinical outcomes and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis. Method: All studies comparing the constant score (CS), range of motion (ROM), and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis were included. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through March 31, 2019. No restrictions were placed on language of publication. Results: A total of 6 studies met the inclusion criteria and were analyzed in detail. Overall postoperative ROM (95% CI: 3.27 to 11.92; P < .01) was significantly greater for stemless prosthesis compared to conventional stemmed prosthesis. However, postoperative CS (95% CI: −2.98 to 7.13; P = .42) and complication rates (OR 1.22, 95% CI: 0.48–3.08; P = .68) were did not differ significantly between the 2 groups. Conclusion: This meta-analysis revealed that postoperative CS and complication rates did not differ significantly between the 2 treatment methods, stemless shoulder prosthesis and conventional stemmed shoulder prosthesis, for shoulder arthropathy. However, stemless shoulder prosthesis resulted in better outcomes than conventional stemmed shoulder prosthesis in terms of postoperative ROM. Level of evidence: Level III, Therapeutic study.

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Posterior-stabilized inserts are preferable to cruciate-substituting ultracongruent inserts due to more favourable kinematics and stability

Abstract: Therapeutic study, Level II.

Cited by 32 publications

References 35 publications

Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty

Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty

Condylar‐Stabilized TKR May Not Fully Compensate for PCL‐Deficiency: An In Vitro Cadaver Study

Comparison of stemless and conventional stemmed shoulder arthroplasties in shoulder arthropathy

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