Background: Total knee arthroplasty is a well-established procedure in the management of terminal stage arthritis. Among the techniques (posterior-stabilized vs posterior cruciate retaining total knee arthroplasty) it is unclear whether one design has superior outcome over another. The purpose of the present study was to directly compare clinical and radiological outcomes of these two designs. Methods: A prospective study involving 29 patients who received a cruciate-retaining implant were compared to 30 patients who received posterior-stabilized prosthesis. The patients were followed up at 3 monthly intervals in the first year and 6 monthly thereafter. At 2years follow-up time clinical and radiological evaluation done and results were analyzed. Results: At 2 years follow-up time mean knee society scores improved from 47.19/34.2 (clinical/functional score) points to 91.9/89.25 points in the cruciate-retaining group and from 46.2/37.5 (clinical/functional score) points to 93.4/92.2 points in the posterior-stabilized group. The ranges of motion were 120.2° (range, 90° to 130°) and 125.3° (range, 100° to 140°) in the cruciate-retaining and posterior-stabilized group respectively, at 2-year follow-up. One had superficial infection (treated with dressing) and one patient with superficial infection required debridement. Conclusions: This study did not conclusively demonstrate the superiority of one knee design over the other, but clinical and functional score and range of motion were marginally better in patients with posterior stabilized implants which were not statistically significant.
Twenty-eight total knee replacement (TKR) surgeries were performed using cruciate retaining implants at Sanjay Gandhi institute of trauma and orthopedics from October 2016 to October 2018. All patients were evaluated pre-operatively & post-operatively with knee society clinical, functional score. Average pre-operative knee society clinical score was 47.1 & functional score was 34.32. Main indication for T.K.R was osteoarthritis. Follow up period ranged from 6 months to 2 years. 96.5% of our patients scored 80 points or better for a rating of excellent by knee society clinical, functional score system. The mean post-operative knee society clinical score was 91.6, knee society functional score was 89.28. 90% patients had little/no pain post operatively, whereas walking ability similarly improved & was unlimited in 85% of the patients postoperatively. Average alignment of prosthesis was 4.9 degrees valgus. No radiolucency's about the tibial component &femoral component were found at the end of 2 years of follow up. No evidence of D.V.T /pulmonary embolism. Post-operative complications included knee stiffness in 2 post op cases, extensor lag in 2 cases, post-operative surgical site infection in 2 post-operative case and persistent fixed flexion and varus deformity in 1 case. 96.5% of the patients had excellent results (knee score of>80) 3.6% of the patients had good (knee score between 60 to 80) results. T.K.R provided pain relief, adequate stability, and measurable change in the range of motion in severely painful, refractory unstable knees. Total knee arthroplasty has in the past 4 decades revolutionized the treatment of primary osteoarthritic and secondary osteoarthritic knees. With these excellent results we conclude that cruciate retaining total knee arthroplasty provided measurable pain relief, adequate stability, remarkable range of motion in severely painful knees refractory to conservative management. If performed taking into consideration proper selection of patients, meticulous attention to surgical technique and asepsis, Intra-operative soft tissue balancing, correct alignment of prosthesis and postoperative rehabilitation of patients, cruciate retaining total knee replacement has yielded excellent results. By this we can conclude that cruciate retaining total knee replacement is an established effective surgery in the treatment of osteoarthritic knees.
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