Comparing patient reported outcomes in depuy sigma curved versus curved plus polyethylene inserts in cruciate retaining total knee arthroplasty

O’Donnell, Ryan; Brown, Kelsey; Krueger, Van; Glasser, Jillian; Antoci, Valentin

doi:10.1016/j.jor.2021.01.017

Cited by 1 publication

(11 citation statements)

References 13 publications

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“…The statistically significant differences observed in this study were small and hence not clinically significant.There was no significant difference in functional outcomes in nine studies [1, 13, 16, 26, 27, 30, 34, 35, 38]. In contrast, two studies showed that functional outcomes were better using UC insert [20, 31], and one study reported better functional outcomes with standard CR insert [29].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there were variations in the assessment of duration of final follow‐up assessment (range 1 year to 5.5 years). O’Donnell et al [29] included non‐inflammatory arthritis, Meding et al [26] included inflammatory and non‐inflammatory arthritis, and Mont et al [27] did not specify inclusion and exclusion criteria and these are suggestive of variations in the indications of TKA that were observed in the published studies. Patients undergoing TKA for inflammatory knee arthritis have better functional outcomes than those undergoing TKAfor non‐inflammatory arthritis [5].…”

Section: Discussionmentioning

confidence: 99%

“…Plausible explanations for heterogeneity include variation in the duration of final follow‐up (range 1 to 7 years), age of patients (range from a mean age of 65.7 to 70 years), and indications for TKA. The study by Donnell et al [29] can be considered an outlier due to the extremely low standard deviation value of SF‐12 PCS compared to other included studies. Sensitivity analysis performed after excluding the outlier study led to significant homogeneity ( I 2 = 0%) and no difference was observed between the two inserts (WMD = − 2.0; 95% CI − 4.7 to 0.6; p = n.s.…”

Section: Discussionmentioning

confidence: 99%

“…The post of the posterior stabilized (PS) polyethylene insert and the cam on the PS femoral prosthesis [28] prevent this. The standard cruciate‐retaining (standard CR) polyethylene has a relatively flat surface and using the standard CR insert in the presence of an incompetent or deficient PCL leads to posterior sagging of the knee and consequent flexion instability during physiological loading of the knee [29].…”

Section: Introductionmentioning

confidence: 99%

“…Ultracongruent (UC) inserts were developed to overcome the above limitation, by having a deep‐dish surface to provide stability in the sagittal plane.The high anterior lip acts to reduce or preventthe paradoxical anterior femoral translation during knee flexion [20, 25, 29, 30]. Furthermore, UC insert preserve the femoral bone stock in the intercondylar notch, avoid patellofemoral clunk syndrome, and the polyethylene postwear [12, 25, 28, 41].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Equivalent outcomes of ultra-congruent and standard cruciate-retaining inserts in total knee arthroplasty

Vishwanathan

Kambhampati²,

Vaishya

2022

Knee Surg Sports Traumatol Arthrosc

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PurposeNo systematic review has compared the clinical outcome of anterior stabilized ultra‐congruent and standard cruciate‐retaining inserts in fixed‐bearing primary total knee arthroplasty. This study aimed to compare the outcomes and establish the superiority or equivalence of these inserts. MethodsPubmed, EMBASE, Medline, AMED, ERIC, and Proquest databases were searched electronically. PRISMA guidelines were followed in the conduct of the study. The clinical outcomes compared in the meta‐analysis were overall knee score, WOMAC, score for knee function, score for knee pain, SF‐12 PCS, knee flexion, manipulation under anaesthesia for postoperative knee stiffness, revision total knee arthroplasty or change of polyethylene insert for post‐operative instability (relative risk [RR]) and survivorship. Study quality was evaluated using the Newcastle Ottawa Scale and the Modified Jadad scale. ResultsFourteen studies comprising 9989 knees (three RCTs and 11 comparative case‐cohort studies) were included for qualitative and quantitative analysis. The pooled analysis of the ultracongruent insert and the standard cruciate retaining insert was based on a cohort of 2860 and 7129 TKA, respectively. Knee pain was significantly better in patients that had standard inserts (p = 0.02; 95% CI − 1.06 to − 0.10), and the physical component of health‐related quality of life was also significantly better in patients that had standard inserts (p = 0.02; 95% CI − 6.43 to − 0.64). There was a 72% lesser chance of revision TKA or change of insert for postoperative instability in knees that had been implanted with ultracongruent inserts (RR = 0.28; p = 0.0002; 95% CI 0.15–0.55). There was no difference in the otheroutcome measures. There was no significant difference between the two inserts, considering the minimal clinically important difference or absolute ratio. ConclusionDifferences observed between the two types of inserts were not clinically significant. Therefore, based on current evidence, arthroplasty surgeons can use either of these inserts with cruciate‐retaining knee prosthesis. Level of evidenceTherapeutic study, Level II.

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