Total knee arthroplasty using ultra-congruent inserts can provide similar stability and function compared with cruciate-retaining total knee arthroplasty

Song, Eun-Kyoo; Lim, Hong-An; Joo, Sang-Don; Kim, Sung Kyu; Lee, Keun-Bae; Seon, Jong-Keun

doi:10.1007/s00167-017-4553-3

Cited by 45 publications

(35 citation statements)

References 23 publications

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“…However, in their case they did not report any statistically significant differences in AP laxities between implant designs (except at 0°). Song et al 7 reported total AP laxity of the CR and UC knees in flexion to be 6.8 ± 3.5 mm and 7.5 ± 2.3 mm, respectively, but significant differences. Both previous studies reported larger VV laxities than what was measured in the current study, however, a similar outcome was reported (no effect due to bearing design).…”

Section: Discussionmentioning

confidence: 97%

“…In terms of stability, at least two previous studies compared the AP and VV laxity of CR and “ultra‐congruent” (UC) TKR in patients, but for a different TKR system intra‐operatively using a navigation system. Table compares the results of Lützner et al with the current study, in terms of overall AP and VV laxities.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

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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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

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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No difference in patient‐reported outcomes or range of motion between ultracongruent and posterior stabilized total knee arthroplasty: A randomized controlled trial

Macedo,

Lucas,

Cunha

et al. 2024

J. exp. orthop.

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PurposeUltracongruent (UC) inserts were designed to overcome potential issues with posterior stabilized (PS) inserts, including bone resection, post‐breakage, and patellar clunk syndrome. However, there remains a shortage of high‐quality studies directly comparing this insert design to the established PS Total Knee Arthroplasty (TKA). This prospective randomized controlled trial (RCT) aimed to compare clinical outcomes, range of motion, and complications of UC and PS TKA.MethodsNinety six patients with primary knee osteoarthritis were randomly assigned to either the PS or the UC group. There were no significant differences between the groups regarding age, body mass index, sex, or Osteoarthritis grade. The measured outcomes were Knee Injury and Osteoarthritis Outcome Score (KOOS) and Range of Motion (ROM), recorded preoperatively and at 3 and 6 months postoperative. Both the patient and interviewer were blinded to the allocation group.ResultsEighty one patients were included in the analysis, with a mean follow‐up of 1.3 years. Both groups exhibited a gradual improvement in KOOS. Still, no statistically significant differences were observed between the groups during the follow‐up examinations at 3 or 6 months in KOOS or range of motion. No complication occurred in either group during the follow‐up period.ConclusionBoth designs demonstrated comparable positive outcomes, reinforcing the viability of UC designs as an alternative to the well‐established PS TKA.Levels of EvidenceLevel l, randomized controlled trial.

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No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial

Aktı

Karakuş

Sezgin

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacriicing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCLsacriicing TKA. Methods Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no signiicant diferences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. Results There were no signiicant diferences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no signiicant diferences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and lexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). ConclusionThe use of UC or PS inserts in TKA did not afect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential diferences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacriicing the PCL in TKA. Level of evidence I.

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Total knee arthroplasty using ultra-congruent inserts can provide similar stability and function compared with cruciate-retaining total knee arthroplasty

Abstract: II.

Cited by 45 publications

References 23 publications

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

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

No difference in patient‐reported outcomes or range of motion between ultracongruent and posterior stabilized total knee arthroplasty: A randomized controlled trial

No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial

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