Fluoroscopic and radiostereometric analysis of a bicruciate-retaining versus a posterior cruciate-retaining total knee arthroplasty: a randomized controlled trial

Abstract

Aims The aim of this study was to compare a bicruciate-retaining (BCR) total knee arthroplasty (TKA) with a posterior cruciate-retaining (CR) TKA design in terms of kinematics, measured using fluoroscopy and stability as micromotion using radiostereometric analysis (RSA). Methods A total of 40 patients with end-stage osteoarthritis were included in this randomized controlled trial. All patients performed a step-up and lunge task in front of a monoplane fluoroscope one year postoperatively. Femorotibial contact point (CP) locations were determined at every flexion angle and compared between the groups. RSA images were taken at baseline, six weeks, three, six, 12, and 24 months postoperatively. Clinical and functional outcomes were compared postoperatively for two years. Results The BCR-TKA demonstrated a kinematic pattern comparable to the natural knee’s screw-home mechanism in the step-up task. In the lunge task, the medial CP of the BCR-TKA was more anterior in the early flexion phase, while laterally the CP was more posterior during the entire movement cycle. The BCR-TKA group showed higher tibial migration. No differences were found for the clinical and functional outcomes. Conclusion The BCR-TKA shows a different kinematic pattern in early flexion/late extension compared to the CR-TKA. The difference between both implants is mostly visible in the flexion phase in which the anterior cruciate ligament is effective; however, both designs fail to fully replicate the motion of a natural knee. The higher migration of the BCR-TKA was concerning and highlights the importance of longer follow-up. Cite this article: Bone Joint J 2023;105-B(1):35–46.

Knee kinematics are not different between asymmetrical and symmetrical tibial baseplates in total knee arthroplasty: A fluoroscopic analysis of step‐up and lunge motions

“…Although step-up and lunge motions are regularly used in fluoroscopic studies, they are not part of (complex) daily life motions. The platform height of 18 cm high was used in previous studies [22,31]. This height, allowing 90°knee flexion in most patients, is sufficient to investigate differences in knee kinematics of TKA designs.…”

What’s New in Adult Reconstructive Knee Surgery

“…A separate analysis of AJRR data revealed that, when compared with minimally stabilized implants (cruciate-retaining, anterior-stabilized, and pivot-bearing designs), posterior-stabilized implants had a significantly higher risk of all-cause revision (HR, 1.25; p < 0.0001) and revision for infection (HR, 1.18; p = 0.02) 41 . A bicruciate-retaining TKA design exhibits a different kinematic pattern in early flexion and late extension compared with a posterior cruciate-retaining TKA design, according to a recent report 42 . Significantly higher tibial migration was observed in the bicruciate-retaining group; as a result, longer follow-up of the newer bicruciate-retaining TKA design is warranted.…”

In Vivo Total Ankle Arthroplasty Kinematic Evaluation: A Prospective Radiostereometric Analysis

“…The understanding of the relative motion of the prosthetic components is therefore crucial to improve the sub-optimal results obtained with the first dedicated designs and assess the efficacy of the newest ones [8]. Model-based dynamic radiostereometric analysis (MB-RSA) has already been proven as a useful tool for the evaluation of total joint prosthesis kinematics in vivo and under the weight-bearing condition [9][10][11]. MB-RSA can be used to assess in vivo 3D kinematics of the prosthetic components with sub-millimetric accuracy for both rotations and translations [12].…”