Cruciate Retaining compared with Posterior Stabilised Nexgen total knee arthroplasty: results at 10 years in a matched cohort

Abstract

INTRODUCTION Debate has persisted for many years about whether to sacrifice or replace the posterior cruciate ligament when performing total knee arthroplasty. A paucity of long-term follow-up studies comparing outcomes between cruciate-retaining and posterior-stabilised knees exist. We aimed to compare results at ten-year follow-up. METHODS A matched paired study comparing a cohort of 107 Zimmer Nexgen® Cruciate Retaining (CR) patients with a cohort of 107 Nexgen Posterior-Stabilised (PS) knees matched for age, sex, body mass index and preoperative American Knee Society score was undertaken. All patients underwent independent clinical assessment and knee society scoring preoperatively and at 1, 3, 5, 7 and 10 years postoperatively. RESULTS Fifty-three patients (49.5%) in the CR group and 44 patients (41.1%) in the PS group were alive at 10-year follow-up. There were no significant differences between the CR and PS groups with regards to functional assessment (P = 0.95), overall range of movement (P = 0.46) or patient satisfaction (P = 1.0) at 10 years. However, there was a significantly better score improvement in range of movement in PS knees compared with CR knees (P = 0.027). There were six revisions (5.6%) in the PS group and 1 (0.93%) in the CR group (P = 0.12). Both CR and PS knees showed excellent survivorship with no significant difference at 10 years (P = 0.068). CONCLUSIONS There were no significant differences in functional score, overall range of motion or patient satisfaction between the Nexgen cruciate retaining and posterior stabilised total knee arthroplasty at 10-year follow-up. However, PS knees had a greater score improvement in range of motion compared with CR knees.

Ten-Year Results of the Press Fit Condylar Sigma Cobalt–Chrome Total Knee Replacement

“…It is relevant to look at the published results for other designs of TKA, which have reported survival rates of 97 to 100% for aseptic loosening at 10 years postimplantation. [11][12][13][14][15][16][17] This places the survival of this prosthesis design comparable with the previous design as well as other condylar designs at 10 years postimplantation. This provides reassurance for both surgeons and patients that this device, with a design change from its predecessor, performs as well as its predecessor and other devices of a similar class.…”

Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison With a Minimum Follow-Up of 10 Years

“…Mean final follow-up from index TKA to the last assessment was 13.4 (range, [10][11][12][13][14][15] years in the CR group, and 12.7 (range, 10-15) years in the PS group. All clinical scores significantly improved from preoperative to last follow-up in both groups (p= 0.001).…”

“…To our knowledge, only studies have reported on the comparative clinical outcomes with follow-up over 10 years [13][14][15] and with controversial findings. In agreement with us, Mayne et al [15] found similar functional scores, ROM and revision rate between both designs. Likewise, Beaupre et al [13] found no differences in functional outcomes or revisions, although ROM data were not reported.…”

“…There were a large number of publications examining the clinical differences between CR and CS designs, but most of them had small size and a follow-up as short as 5 years and the findings on clinical outcomes were controversial [9][10][11][12]. As far as we know, only 3 studies have reported comparative clinical outcomes with a minimum follow-up of 10 years [13][14][15]. One of these [13] was a randomized study of 62 patients at 2 years and then reviewed at 10 years where the authors reported similar ROM and functional outcomes.…”

“…One of these [13] was a randomized study of 62 patients at 2 years and then reviewed at 10 years where the authors reported similar ROM and functional outcomes. The 2 other were retrospective comparative studies with follow-up of 10 years, one of which reported better ROM and function in the PS group [14], and the other better ROM in PS group but similar functional scores [15]. Thus, evidences on long-term functional outcomes are limited and controversial.…”