Higher mid-term revision rates of posterior stabilized compared with cruciate retaining total knee arthroplasties: 133,841 cemented arthroplasties for osteoarthritis in the Netherlands in 2007–2016

Abstract

Background and purpose — The preference for a cruciate retaining (CR) or posterior stabilized (PS) TKA (total knee arthroplasty) system varies greatly between Dutch hospitals, independent of patient characteristics. We examined mid-term revision rates for men and women of different age categories.Patients and methods — We included all 133,841 cemented fixed-bearing primary CR or PS TKAs for osteoarthritis reported in the Dutch Arthroplasty Register (LROI) in 2007–2016. Revision procedures were defined as minor when only insert and/or patella were revised and as major when fixed components (tibia and femur) were revised or removed. 8-year all-cause revision rates of CR and PS TKAs were calculated using competing-risk analyses. Cox-regression analyses were performed, adjusted for age at surgery, sex, ASA -score, and previous operations.Results — PS TKAs were 1.5 (95% CI 1.4–1.6) times more likely to be revised within 8 years of the primary procedure, compared with CR TKAs. When stratified for sex and age category, 8-year revision rate of PS TKAs in men <60 years was 13% (CI 11–15), compared to 7.2% (CI 6.1–8.5) of CR TKAs. Less prominent differences were found in older men and women. For men <60 years differences were found for minor (CR 1.8% (CI 1.4-2.5); PS 3.7% (CI 3.0–4.7)) and major revisions (CR 4.2% (CI 3.3–5.3); PS 7.0% (CI 5.6–8.7)).Interpretation — Patients who received a cemented fixed-bearing primary PS TKA for osteoarthritis are more likely to undergo either a minor or a major revision within 8 years. This is especially prominent for younger men.

Patellar Resurfacing in Primary Total Knee Arthroplasty: A Meta‐analysis and Trial Sequential Analysis of 50 Randomized Controlled Trials

“…The revision was categorized as non‐patellar (i.e., due to tibia or femoral‐related complications) and patellar revisions (due to patellar‐related complications), as referenced in a previous study 2 . Patellar resurfacing was associated with reduced non‐patellar and patellar revisions, in line with an investigation in the Netherlands 74 and previous meta‐analysis 2,4–13,75 . In our analysis, the number needed to treat (NNT) to prevent one revision was 13 knees, compared to 25 in Teel's study 5 .…”

Late stabilization after initial migration in patients undergoing cemented total knee arthroplasty: a 5-year followup of 2 randomized controlled trials using radiostereometric analysis

“…Therefore, it is quite uncertain whether these differences influence long-term migration, which should be further investigated, such as by assessing migration using certain feature points of the implant (e.g., medial border of the tibial component). However, minor changes in TKA design could have clinical effects as a recent study comparing revision rates of CR designs with PS designs in the Dutch arthroplasty registry found that PS designs had higher revision rates (28).…”

Prosthesis design of animal models of periprosthetic joint infection following total knee arthroplasty: A systematic review

“…In clinical practice, according to whether the posterior cruciate ligament is preserved, there are two kinds of prostheses, including posterior CR prostheses and posterior cruciate-stabilized prosthesis (PS) [60, 61]. The CR prosthesis can better simulate the rolling mechanism and biomechanical characteristics of the normal knee, and achieve higher proprioceptive sensation [28].…”