Posterior-stabilized versus cruciate-retaining total knee arthroplasty

Tänzer, Michael; Smith, Karen; Burnett, Stephen

doi:10.1054/arth.2002.34814

Cited by 112 publications

(72 citation statements)

References 16 publications

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“…We also observed a low incidence of early aseptic loosening (six of 698 [0.9%]) that is comparable to conventional implants [4,10,29,44,48]. The results of this study support several others reporting no or few loosening cases with the same HF prostheses [18,25,26,39,40,43,50] (Table 3).…”

Section: Discussionsupporting

confidence: 87%

“…Both studies suggested this substantial early aseptic loosening was associated with postoperative deep flexion ability. 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].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 87%

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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“…Long-term survival rates and functional abilities are comparable in cruciate-retaining and cruciate-substituting (posterior stabilized) prostheses (52). To improve patient satisfaction and function, implants have been modified to permit an increased arc of flexion that may approach 150 degrees of knee flexion (53).…”

Section: Total Knee Arthroplastymentioning

confidence: 99%

Update on hip and knee arthroplasty: Current state of evidence

Jones¹,

Westby²,

Greidanus³

et al. 2005

Arthritis & Rheumatism

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“…PCL substitution in primary TKA has traditionally relied on a cam and post (cam-post) mechanism in the form of a posterior-stabilized (PS) design. Short-and long-term evaluations of PS and CR knees have failed to show clinically significant differences in their outcomes [2,11,12,[17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Total Knee Arthroplasty With Highly Congruent Anterior-stabilized Bearings versus a Cruciate-retaining Design

Peters

Mulkey

Erickson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The use of a highly conforming, anteriorstabilized bearing has been associated with clinical success in a limited number of studies. Questions/purposes We compared Knee Society scores, radiographic results, complication rates, and revision rates with the use of anterior-stabilized bearings compared with cruciate-retaining (CR) bearings. Methods A series of 382 patients with 468 primary total knee arthroplasties (TKAs) between 2003 and 2008 with minimum 2-year followup were reviewed. Anterior-stabilized bearings comprised 49% (n = 228) of the sample and CR bearings consisted of 51% (n = 240). The decision to use an anterior-stabilized bearing was based on integrity of the posterior cruciate ligament (PCL) intraoperatively or after sacrifice of the PCL to achieve soft tissue balance. The tibial and femoral component designs were the same regardless of bearing choice. Outcomes were measured with Knee Society scores, complications, revision TKA, and survival.Radiographs were analyzed for component alignment and evidence of loosening. Results There was no difference in Knee Society knee scores, radiographic alignment, component loosening, manipulation rate, major complications, or time to revision for patients between the two groups. However, the CR group had significantly more revisions than the anteriorstabilized group (21 CR [1.5%] versus seven anteriorstabilized [4.6%], p = 0.03) at a minimum followup of 5 months (mean, 42 months; range, 5-181 months). Conclusions The use of a highly congruent anteriorstabilized bearing for PCL substitution has comparable clinical and radiographic results to traditional CR TKA. These results suggest that this approach is an effective method to achieve stability without the PCL in primary TKA. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Posterior-stabilized versus cruciate-retaining total knee arthroplasty

Cited by 112 publications

References 16 publications

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

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

Update on hip and knee arthroplasty: Current state of evidence

Comparison of Total Knee Arthroplasty With Highly Congruent Anterior-stabilized Bearings versus a Cruciate-retaining Design

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