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

Lee, Sung-Sahn; Yeom, Jaewoo; Lee, Dae-Hee; Moon, Young-Wan

doi:10.1177/2309499019893515

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…Despite the different patterns of posterior tibial translation, the clinical outcomes observed in this study when using UC or PS designs are similar, and this is consistent with previous findings of some other studies with mobile‐bearing [14, 15, 19] or fixed‐bearing TKA [1, 13, 16, 23]. This study has also found similar functional outcomes between UC and PS designs, as it has been previously described in some studies [4, 21].…”

Section: Discussionsupporting

confidence: 92%

Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial

Hinarejos

Leal-Blanquet

Fraile-Suari

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose:The aim of this study was to compare the posterior tibial translation after ultracongruent (UC) and posterior-stabilized (PS) total knee arthroplasty (TKA) with two different UC with different heights in the anterior lip, and two different PS designs. This study also aimed to compare the range of motion (ROM) and outcomes scores after the use of these TKA models. It was hypothesised less posterior tibial translation after PS than after UC TKA, and less posterior tibial translation with a higher anterior lip in the UC insert than with a lower one.Methods: It was designed as a prospective randomized study of a group of 120 patients operated with a cemented TKA. In order to clarify the main purpose of the study, four groups were analysed using different polyethylene designs: Triathlon PS insert in group one, Triathlon UC insert in group two, U2 PS insert in group three and U2 UC insert in group four. One year after surgery, a forced posterior drawer with a Telos Stress applying 15 Kg of force posteriorly on the proximal tibia at 90° of knee flexion was analysed in the lateral radiograph. Limb alignment, tibial posterior slope and posterior condylar offset were also studied.Results: 30 patients were included in each group. The average age was 73 years. There were 72.2% female and 27.8% male patients. There were no significant differences in any demographic or radiographic studied variables, preoperative range of motion (ROM) or preoperative Knee Society Scores (KSS) among the different groups. One year after surgery, the average postoperative ROM and the postoperative KSS Knee and KSS Function scores improved in respect of the preoperative values in all the groups. There were no significant differences in the postoperative outcome scores among the different groups (p=n.s.). Postoperative alignment of the limb, tibial posterior slope and posterior condylar offset were similar in the 4 study groups (p=n.s.). The postoperative posterior tibial translation was different between groups: the PS groups (groups 1 and 3) showed significant inferior values (p<0.001) in respect of the UC groups (groups 2 and 4). There were no differences between both groups of PS models, but there was a significant increase in the posterior tibial translation of the Triathlon UC insert (11.2 mm SD 3.2) in respect of the U2 UC insert (6.1 mm SD 4.5) (p=0.004).Conclusions: UC inserts restrict the posterior tibial translation after TKA less than PS inserts, but a design with a high anterior lip in the polyethylene UC insert can better control the posterior tibial translation than an insert with a small anterior lip.

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Section: Discussionsupporting

confidence: 92%

Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial

Hinarejos

Leal-Blanquet

Fraile-Suari

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…In this category of mobile inserts, a further distinction between standard and ultra-congruent inserts can also be made. Compared to the standard ones, ultra-congruent inserts are characterized by an increased anterior buildup, providing a more conforming articular surface that better matches the radius of the femoral component [19]. These inserts are able to guarantee a good anterior-posterior stability without the need of a metal cam [20,21], and with the even increased congruency, contact stress peaks are theoretically avoided, providing better stressforces distribution [21].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical analysis of different levels of constraint in TKA during daily activities

Castellarin¹,

Bori

Rapallo

et al. 2023

Arthroplasty

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Background Numerous total knee prosthetic implants are currently available on the orthopedic market, and this variety covers a set of different levels of constraint: among the various models available, a significant role is covered by mobile bearing cruciate-retaining design with an ultra-congruent insert, mobile bearing cruciate-retaining design, fixed-bearing posterior stabilized prosthesis and fixed-bearing constrained condylar knee. A biomechanical comparative study among them could therefore be helpful for the clinical decision-making process. This study aimed to compare the effect of these different levels of constraint in the knee biomechanics of a patient, in three different configurations representing the typical boundary conditions experienced by the knee joint during daily activities. Method The investigation was performed via finite element analysis with a knee model based on an already published and validated one. Four different types of prosthesis designs were analyzed: two mobile-bearing models and two fixed-bearing models, each one having a different level of constraint. The different designs were incorporated in to the 3D finite element model of the lower leg and analyzed in three different configurations reproducing the landing and the taking-off phases occurring during the gait cycle and chair-rising. Implant kinetics (in terms of polyethylene contact areas and contact pressure), polyethylene and tibial bone stresses were calculated under three different loading conditions for each design. Results The tibial stress distribution in the different regions of interest of the tibia remains relatively homogeneous regardless of the type of design used. The main relevant difference was observed between the mobile and fixed-bearing models, as the contact areas were significantly different between these models in the different loading conditions. As a consequence, significant changes in the stress distribution were observed at the interface between the prosthetic components, but no significant changes were noted on the tibial bone. Moreover, the different models exhibited a symmetrical medial and lateral distribution of the contact areas, which was not always common among all the currently available prostheses (i.e. medial pivot designs). Conclusion The changes of the prosthetic implant did not induce a big variation of the stress distribution in the different regions of the tibial bone, while they significantly changed the distribution of stress at the interface between the prosthetic components.

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“…Furthermore, there was post-cam mechanism polyethylene wear and a risk of dislocation [42,43], and the patella clunk syndrome might have occurred [44]. For many TKA brands, anterior-lipped ultracongruent (UC) J o u r n a l P r e -p r o o f inserts are available for when PCLs are damaged or resected, but increased constraint is provided by a "deep dish" polyethylene geometry instead of a post-cam mechanism [45][46][47][48][49]. Song et al reported no differences in mediolateral or anteroposterior laxity between UC TKA and CR TKA in stress radiographs at full extension, and concluded that UC inserts can be a good option in TKA without bony box cuts when the PCL is damaged during an operation [50].…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

“…Song et al reported no differences in mediolateral or anteroposterior laxity between UC TKA and CR TKA in stress radiographs at full extension, and concluded that UC inserts can be a good option in TKA without bony box cuts when the PCL is damaged during an operation [50]. Moreover, UC TKA is a safe alternative to PS TKA and similarly has good clinical outcomes if cruciate substitution is necessary in randomized control trials and propensity score-matched analyses [46,51,52]. Furthermore, the joint perception and isokinetic performance were similar between UC TKA and PS TKA [52,53].…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Cruciate-Retaining vs Posterior-Stabilized Antibiotic Cement Articulating Spacers for Two-Stage Revision of Prosthetic Knee Infection: A Retrospective Cohort Study

Lin

Tsai

Fong

et al. 2021

The Journal of Arthroplasty

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

Cited by 13 publications

References 32 publications

Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial

Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial

Biomechanical analysis of different levels of constraint in TKA during daily activities

Cruciate-Retaining vs Posterior-Stabilized Antibiotic Cement Articulating Spacers for Two-Stage Revision of Prosthetic Knee Infection: A Retrospective Cohort Study

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