Similar stability and range of motion between cruciate-retaining and cruciate-substituting ultracongruent insert total knee arthroplasty

Lützner, Jörg; Firmbach, F.-P.; Lützner, Cornelia; Dexel, Julian; Kirschner, S.

doi:10.1007/s00167-014-2892-x

Cited by 50 publications

(49 citation statements)

References 16 publications

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“…25,35 Although this is thought to lead directly to greater instability, this causative relationship has not been objectively demonstrated in vivo. Furthermore, Lützner et al 33 found similar intraoperative stability between the two constructs, with no statistical difference. Despite the difference in femoral rollback, both PS and CR TKAs have been proven to provide a similar improvement in stability both intraoperatively and for outcome scores postoperatively.…”

Section: Discussionmentioning

confidence: 94%

“…Even though a statistically significant difference in ROM between PS and CR groups was detected, both the underreporting of results and the difference in follow-up times may influence our results. For example, there were differences in the definition of postoperative, most reporting at 2 years 5,8,19,23,28,30,32,33,36,38,40,42,43,45 and some at 5 years. 2,3,9,14,17 Also, it is difficult to know at what time assessment was undertaken postoperatively for those who did not clarify their methods of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Complications were reported in only 17 of the 37 studies (45.9%). 3,[5][6][7]14,19,20,22,28,30,32,33,[35][36][37]44,45 There was an overall complication rate of 3.9% (213 complications in 5,407 knees). The meta-analysis 3,6,20,22,29,35,45 showed that no statistical difference was found between the two procedures (95% CI, 0.78-2.31; p ¼ 0.29).…”

Section: Range Of Motion and Complicationsmentioning

confidence: 99%

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Outcomes of Posterior-Stabilized Compared with Cruciate-Retaining Total Knee Arthroplasty

et al. 2017

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The aim of this systematic review is to compare clinical outcome scores, rate of complications, and range of motion (ROM) of posterior-stabilized (PS) and cruciate-retaining (CR) total knee arthroplasties (TKAs) both pre- and postoperatively to establish which of the two kinds of implants have the best efficiency. A comprehensive search was performed of studies comparing CR and PS TKAs on PubMed, OVID/Medline, Cochrane, CINAHL, Google scholar, and Embase databases. Finally, 37 studies were selected with a total of 5,407 knees in 4,445 patients. For the PS knees, the Knee Society Functional Score (KSFS) improved from 44.6 to 77.6 ( = 0.04), extension decreased from 6.6 to 1.8 degrees (-value), and flexion increased from 115.2 to 119.4 degrees ( < 0.00001), compared with the CR knees. No significant difference in the Knee Society objective score (KSOS) ( = 0.82) or complication rates ( = 0.29) was found. The overall complication rate was 3.9%, 213 in 5,407 knees. Surgeons must be careful in interpreting these results, as an improved ROM for the PS group may not correlate to better patient outcomes. This meta-analysis has demonstrated that PS TKA has a statistically significant greater postoperative improvement of KSFS ( = 0.04), flexion ( < 0.00001), and extension ( = 0.02), compared with the CR group. These findings seem to lead the surgeons to prefer the PS design for TKAs especially to achieve a higher postoperative ROM in patients with high functional demands. On the contrary, the CR and PS TKAs have similar results in terms of complications and most of clinical outcomes analyzed in the included studies. Therefore, the long-term follow-up of high-quality randomized controlled trials is needed to clarify which of the two types of prosthesis provide the better clinical outcome and the lower rate of complications for osteoarthritis patients in particular cohorts. This is a systematic review (level II).

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Range Of Motion and Complicationsmentioning

confidence: 99%

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Outcomes of Posterior-Stabilized Compared with Cruciate-Retaining Total Knee Arthroplasty

et al. 2017

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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%

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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“…Although further evaluations are required, intraoperative navigation can measure knee kinematics during surgery and may assist surgeons to optimize knee kinematics or identify abnormal knee kinematics that could be corrected with ligament releases to improve the functional result of TKA. 23 Lützner et al 24 evaluated stability and ROM in standard cruciate-retaining (CR) and cruciate-substituting UC inserts of the same TKA. Their study demonstrated similar mediolateral laxity with the UC insert compared with the CR insert.…”

Section: Discussionmentioning

confidence: 99%

Factors Contributing to Patient Satisfaction and Expectations following Computer-Assisted Total Knee Arthroplasty

et al. 2017

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The purpose of this study was to determine which factors contribute to patient satisfaction and expectations after total knee arthroplasty (TKA). A total of 109 patients (130 knees) with knee osteoarthritis who underwent primary TKA with navigation were studied. Intraoperative mediolateral laxity was measured. The factors including mediolateral laxity that affected patient satisfaction and expectations were evaluated using the 2011 Knee Society Score. Patient satisfaction after TKA correlated positively with symptoms and functional activities, and negatively with old age in univariate analysis. Multivariate analysis showed that symptoms and functional activities remained statistically significant; however, old age showed no difference. Patient expectations after TKA correlated positively with symptoms and functional activities, and negatively with mediolateral laxity at 60 degrees in univariate analysis. Multivariate analysis showed that symptoms, functional activities, and mediolateral laxity at 60 degrees remained statistically significant. In conclusion, midflexion instability was associated with worse expectations.

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Similar stability and range of motion between cruciate-retaining and cruciate-substituting ultracongruent insert total knee arthroplasty

Abstract: II.

Cited by 50 publications

References 16 publications

Outcomes of Posterior-Stabilized Compared with Cruciate-Retaining Total Knee Arthroplasty

Outcomes of Posterior-Stabilized Compared with Cruciate-Retaining Total Knee Arthroplasty

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

Factors Contributing to Patient Satisfaction and Expectations following Computer-Assisted Total Knee Arthroplasty

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