Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatment of valgus osteoarthritis

Savov, Peter; Mielke, E.; Calließ, Tilman; Richter, Alena; Ettinger, Max

doi:10.1007/s00402-020-03618-w

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Symptomatic, postoperative instability has not been reported in the current study, even in those patients with a residual valgus between 6° and 10° (38% of knees in the authors’ cohorts); this finding confirmed previous reports which showed that residual valgus deformity does not necessarily influence the clinical outcome [22]. The overall incidence of postoperative instability in the current study, as reported by the patients in the Forgotten Joint Score questionnaire, was not different from other studies reporting on using higher level of constraint (posterior‐stabilized or semi‐constrained) [12, 13, 29, 33]. This may have been due to the high conformity design of the MC polyethylene insert, which still significantly differs from classical CR polyethylene insert designs.…”

Section: Discussionsupporting

confidence: 88%

“…Aiming for intra‐articular stability might result in soft tissue over‐releasing, component malalignment, increase of polyethylene insert thickness with contemporary joint line elevation, and, finally, unplanned conversion to a constrained prosthesis. Several reports have also shown that patients with excessive valgus preoperative alignment (> 11°) demonstrated a greater risk of construct failure even when corrected to neutral after TKA [29, 30]. Postoperative instability and aseptic loosening from increased stress at the implant–bone interface, due to an elevated degree of intra‐articular constraint, have been described as prime failure modes in this scenario [25].…”

Section: Discussionmentioning

confidence: 99%

“…Historically, surgeons reported major difficulties correcting valgus deformities using conventional instruments without resorting to the use of posterior‐stabilized [33] or constrained implants [7, 28]. Cruciate‐retaining TKA designs, when used to treat valgus malalignment, showed a significantly higher revision rate than posterior‐stabilized designs [29]. Interestingly, classic, medial pivot TKA designs showed favorable outcomes, reaching a 98.8% survivorship at 17 years [24].…”

Section: Discussionmentioning

confidence: 99%

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Medially congruent total knee arthroplasty in valgus knee deformities yields satisfactory outcomes: a multicenter, international study

Indelli

Spinello

Zepeda

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposePostoperative instability represents one of the most common complications following primary total knee arthroplasty (TKA). To prevent this outcome, valgus deformities have been historically treated using more constrained implants. The purpose of this study was to evaluate the outcome of treating a moderate valgus deformity by combining a surgical technique used to release the postero‐lateral soft tissue envelope with the use of a medially congruent (MC) TKA design without using classical, semi‐constrained inserts. MethodsSeventy‐nine MC TKAs were performed by three surgeons at three institutions between 2016 and 2018 as part of a multicenter, international study. Inclusion criteria were: radiographic late‐stage osteoarthritic knees with Ranawat’s type 1 or 2 classification of valgus deformity and integrity of the medial capsular–ligament complex (less than 10 mm of medial opening during valgus stress test at 10° of knee flexion). Exclusion criteria were: BMI > 40; neuromuscular, metabolic, or immunologic disorders; or the inability to complete outcome measures or radiographic assessment. ResultsSeventy‐seven patients (79 knees), 59 males and 18 females, were evaluated at 2‐year minimum follow‐up according to the Knee Society Score (KSS) and Forgotten Joint Score (FJS). Mean age at surgery was 70 years (range 48–91). The mean range of motion (ROM) improved from 110° (range 85°–130°) preoperatively to 121° (range 105°–135°) (p < 0.001) at the time of the last follow‐up. Preoperative knee extension significantly improved from 3° (range − 15° to 20°) to 1° (range − 5° to 5°) of flexion at the last follow‐up in all the patients. KSS and KSS Functional scores were 89 (range 65–100) and 82 points (range 55–100), respectively. The FJS obtained at the last follow‐up was 72 (range 49–88). Two patients (2.5%) had major postoperative complications (one periprosthetic joint infection; one postoperative patellar fracture) requiring surgical interventions. ConclusionsIn different surgeon’s hands, the use of a modern medially congruent TKA design yielded good clinical outcomes at 2 years in a consecutive series of TKA in valgus arthritic knees. Postoperative instability was not recorded in this series and this finding was related to the high conformity design of the MC polyethylene insert, which significantly differs from classical posterior‐stabilized (PS) designs. Level of evidenceIV.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medially congruent total knee arthroplasty in valgus knee deformities yields satisfactory outcomes: a multicenter, international study

Indelli

Spinello

Zepeda

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…However, 8.0% of patients in the CR group had to undergo revision surgery due to instability, as compared to no patients in the PS group. The authors concluded that PS TKA might be the more suitable treatment option for valgus cases [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Higher use of fixed-bearing over mobile-bearing and posterior-stabilized over medial pivot designs in total knee arthroplasty (TKA): a systematic comparative analysis using worldwide arthroplasty registers from England and Wales, Australia, Norway, New Zealand, Germany and Switzerland

Wittig

Moshammer

Vielgut

et al. 2022

Arch Orthop Trauma Surg

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Introduction The aim of this study was to compare the use of mobile-bearing, fixed-bearing, posterior-stabilized (PS) and medial pivot design to describe epidemiological differences and subsequent outcomes. Materials and methods A systematic literature search was performed using the NORE website to identify the relevant arthroplasty registers. Inclusion criteria were the following: (1) reports had to be publicly available, (2) reports had to be written in German or English language, (3) differentiation between mobile- and fixed-bearing, posterior-stabilized, and if possible, medial pivot designs had to be possible from the present reports, and (4) data had to be reported for at least three consecutive years and the latest report had to be from the year 2020 to retrieve recent data. Results Six registries (England and Wales, Australia, Norway, New Zealand, Germany, Switzerland) offered sufficient data according to the inclusion criteria. In all countries, the dominant type of bearing used for total knee arthroplasty (TKA) was fixed-bearing, with percentages ranging from 60.8% to 84.1% in 2018, 63.6% to 85.7% in 2019 and 66.2% to 87.4% in 2020. A large variation was observed concerning mobile-bearing design, which showed a range from 2.8% to 39.2% in 2018, 2.6% to 36.4% in 2019 and 2.9% to 33.8% in 2020. Some variation was found regarding the use of PS TKA, as its percentage frequency ranged from 9.7% to 29.2% in 2018, 9.8% to 29.4% in 2019 and 10.1% to 28.5% in 2020. Medial pivot design had a share of 9.1% in 2018, 8.6% in 2019 and 8.4% in 2020 in Australia, while it only accounted for 1.4% in 2018, 2.1% in 2019 and 2.5% in 2020 in Germany. Conclusion The comparison of arthroplasty registers from England and Wales, Australia, Norway, New Zealand, Germany and Switzerland revealed large differences regarding the application of posterior-stabilized designs, but also common ground considering the overwhelming use of fixed-bearing inserts, which, when inserted correctly, eradicate the potential complication of bearing dislocation. Arthroplasty registers offer a real-world clinical perspective with the aim to improve quality and patient safety.

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“…Savov et al. reviewed patients with valgus OA who underwent either CR or PS TKA, and results showed 8% of patients in the CR group underwent revision due to instability compared to no patients in the PS group [ 48 ].…”

Section: Reviewmentioning

confidence: 99%

Cruciate-Retaining Total Knee Arthroplasty: Current Concepts Review

Yang,

Sohn,

Sambandam

2023

Cureus

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Posterior cruciate-retaining (CR) total knee arthroplasty for osteoarthritis of the knee is a popular implant choice. At present, there is no consensus on whether sacrifice or retention of the posterior cruciate ligament (PCL) offers superior outcomes. This review explores the current literature available on CR total knee arthroplasty (TKA). PubMed was searched by keyword to find relevant articles for inclusion. Additional sources came from article references and joint registry reports. CR design knees have distinct kinematic gait patterns from posterior-stabilizing (PS) knees and exhibit paradoxical anterior femoral movement with less femoral rollback. While CR implants offer less flexion than PS designs, the difference is not clinically detectable as clinical scores are similar in the short and long term. CR implants have better long-term survival compared to PS knees, likely due to lower risk of aseptic loosening. CR total knee arthroplasties also have shorter operating times and lower risk of peri-prosthetic fractures. Because the CR implant is unconstrained, there may be an increased risk of instability compared to PS designs, but the literature is mixed. Overall, the current literature supports the continued use of CR TKAs due to their lower risk of complications, durability, and demonstrated equivalence in function to posterior-substituting models.

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Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatment of valgus osteoarthritis

Cited by 9 publications

References 20 publications

Medially congruent total knee arthroplasty in valgus knee deformities yields satisfactory outcomes: a multicenter, international study

Medially congruent total knee arthroplasty in valgus knee deformities yields satisfactory outcomes: a multicenter, international study

Higher use of fixed-bearing over mobile-bearing and posterior-stabilized over medial pivot designs in total knee arthroplasty (TKA): a systematic comparative analysis using worldwide arthroplasty registers from England and Wales, Australia, Norway, New Zealand, Germany and Switzerland

Cruciate-Retaining Total Knee Arthroplasty: Current Concepts Review

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