Cruciate Retained and Excised Total Knee Arthroplasty A Comparative Study in Patients With Bilateral Total Knee Arthroplasty

Shoji, Hiroto; Wolf, Alan W.; Packard, Steven; Yoshino, Shinichi

doi:10.1097/00003086-199408000-00026

Cited by 58 publications

(28 citation statements)

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“…Recent studies comparing posterior cruciate preservation or sacrifice in patients undergoing bilateral total knee arthroplasties have failed to show substantial differences in their clinical rating scores or functional outcome [4,19,53]. Furthermore, most published clinical reviews retrospectively evaluate a prosthetic device or surgical technique from a small group of surgeons over a period of time, and there appears to be little advantage of a specific approach, regardless of fixation or implant design.…”

Section: Discussionmentioning

confidence: 99%

International multi-centre survivorship analysis of mobile bearing total knee arthroplasty

Stiehl

Hamelynck

Voorhorst³

2006

International Orthopaedics (SICO

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We retrospectively reviewed the experience of a large international multi-centre study of primary total knee arthroplasty with mobile bearing design and modifications of the tibial component to allow for bicruciate preservation, posterior cruciate retention, or sacrifice. Twenty-seven surgeons performed 4,743 total knee replacements between 1981 and 1997. Implants inserted were 324 that retained both cruciate ligaments, 2,165 that retained the posterior cruciate, and 2,254 that sacrificed both cruciates. The patella was resurfaced in 2,838 and unresurfaced in 1,905. With failure defined as revision or reoperation for any reason, the overall survivorship was 79% at 16 years' follow-up. Revision occurred in 259 (5.4%) knees out of the entire cohort. The risk adjusted rates of failure were higher in females, younger patients, osteoarthritis, posttraumatic arthritis, and in patients who had a meniscal bearing prosthesis or patellar resurfacing. The most common cause of revision was bearing-related issues including chronic instability, bearing subluxation, bearing dislocation, or bearing wear in 2.3%.Résumé Nous avons revu rétrospectivement une série multicentrique de prothèses totales primaires de genoux avec plateaux mobiles et pièce tibiale permettant le sacrifice ou la conservation d'un ou des deux ligaments croisés. Entre 1981Entre et 1997 prothèses ont été faite par 27 chirugiens. Les implants utilisés étaient pour 2254 sans ligaments croisés, pour 2165 avec croisé postérieur et pour 324 avec conservation des 2 croisés. La rotule a été resurfacée 2838 fois. Avec l'échec défini par la reprise chirurgicale, la survie était de 79% à 16 ans de recul. Une reprise a été faite 259 fois (5,4%). Le risque d'échec était plus grand chez les femmes, les patients jeunes, en cas d'arthrose primaire ou post traumatique et chez les patients avec une prothèse à ménisques mobiles ou avec une rotule prothèsée. Les causes les plus fréquentes de révision étaient l'instabilité chronique, la subluxation ou la luxation des plateaux mobiles et leur usure.

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Section: Discussionmentioning

confidence: 99%

International multi-centre survivorship analysis of mobile bearing total knee arthroplasty

Stiehl

Hamelynck

Voorhorst³

2006

International Orthopaedics (SICO

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“…PCL substitution in primary TKA has traditionally relied on a cam and post (cam-post) mechanism in the form of a posterior-stabilized (PS) design. Short-and long-term evaluations of PS and CR knees have failed to show clinically significant differences in their outcomes [2,11,12,[17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Total Knee Arthroplasty With Highly Congruent Anterior-stabilized Bearings versus a Cruciate-retaining Design

Peters

Mulkey

Erickson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The use of a highly conforming, anteriorstabilized bearing has been associated with clinical success in a limited number of studies. Questions/purposes We compared Knee Society scores, radiographic results, complication rates, and revision rates with the use of anterior-stabilized bearings compared with cruciate-retaining (CR) bearings. Methods A series of 382 patients with 468 primary total knee arthroplasties (TKAs) between 2003 and 2008 with minimum 2-year followup were reviewed. Anterior-stabilized bearings comprised 49% (n = 228) of the sample and CR bearings consisted of 51% (n = 240). The decision to use an anterior-stabilized bearing was based on integrity of the posterior cruciate ligament (PCL) intraoperatively or after sacrifice of the PCL to achieve soft tissue balance. The tibial and femoral component designs were the same regardless of bearing choice. Outcomes were measured with Knee Society scores, complications, revision TKA, and survival.Radiographs were analyzed for component alignment and evidence of loosening. Results There was no difference in Knee Society knee scores, radiographic alignment, component loosening, manipulation rate, major complications, or time to revision for patients between the two groups. However, the CR group had significantly more revisions than the anteriorstabilized group (21 CR [1.5%] versus seven anteriorstabilized [4.6%], p = 0.03) at a minimum followup of 5 months (mean, 42 months; range, 5-181 months). Conclusions The use of a highly congruent anteriorstabilized bearing for PCL substitution has comparable clinical and radiographic results to traditional CR TKA. These results suggest that this approach is an effective method to achieve stability without the PCL in primary TKA. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…PCL-retaining designs have been shown to be associated with a limited increase in the range of flexion (in comparison with PCL-substituting designs) in certain studies, [3][4][5][6] while no such increase in flexion has been found by others. [7][8][9] Studies which have found increase in flexion have attributed it to higher femoral roll back in PCL-retaining designs. The increased roll back is also said to increase the quadriceps lever arm and the power of extension.…”

Section: Introductionmentioning

confidence: 99%

PCL-retaining versus PCL-substituting TKR – Outcome assessment based on the “forgotten joint score”

Thippanna¹,

Mahesh

Kumar³

2015

Journal of Clinical Orthopaedics and Trauma

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Methods: In this retrospective study, the recently introduced ''forgotten joint score'' (FJS) was used to assess whether any differences exist between the two types of total knee replacement (TKR). FJ scores of 169 patients with PCL-retaining TKA and 178 patients with PCL sacrificing were obtained. The mean follow-up period was 3.5 years and the minimum follow-up period was 2.5 years.Results: Both groups showed high FJ scores indicating that majority of the patients were oblivious to the presence of the artificial joint during daily activities. There was no statistically significant difference between the mean FJ scores of the two groups. Scores of subsets based on gender, age and unilateral and bilateral TKR also did not show significant differences. Conclusions:Since there are no clinically important differences between the two types of TKR, the choice of the TKA should be based on surgeon preferences and training and local conditions of the knee. Patient-reported outcomes appear to be similar regardless of the choice of TKA. Further prospective studies and validation of FJS outcomes with those of other questionnaires are essential to confirm the absence of differences between PCL retention and sacrifice.

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Cruciate Retained and Excised Total Knee Arthroplasty A Comparative Study in Patients With Bilateral Total Knee Arthroplasty

Cited by 58 publications

References 0 publications

International multi-centre survivorship analysis of mobile bearing total knee arthroplasty

International multi-centre survivorship analysis of mobile bearing total knee arthroplasty

Comparison of Total Knee Arthroplasty With Highly Congruent Anterior-stabilized Bearings versus a Cruciate-retaining Design

PCL-retaining versus PCL-substituting TKR – Outcome assessment based on the “forgotten joint score”

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