Intraoperative factors affecting conversion from cruciate retaining to cruciate substituting in total knee arthroplasty

Bae, Dae Kyung; Song, Sang Jun; Kim, Kang‐Il; Hur, Dong Hoon; Lee, Hyun Ho

doi:10.1007/s00167-015-3971-3

Cited by 18 publications

(21 citation statements)

References 42 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The severity of deformity should be considered before surgery. Presence of significant coronal and sagittal malalignment and possibility of difficulty in balancing often necessitate resection of the PCL 1016). A cadaveric study showed that there was significantly less change into valgus after both medial and lateral releases with retention of the PCL 17).…”

Section: Situations Where Cr Tka Is Difficult To Performmentioning

confidence: 99%

“…Baldini et al18) reported that CR TKA performed in patients with a coronal deformity of > 15° was associated with an increased incidence of pain and revision. In addition, PS TKA is a preferred procedure in the presence of fixed flexion contracture, especially in the knee with a fixed flexion contracture of > 20°,1019) because a symmetric flexion and extension gap is easy to obtain when the PCL is resected.…”

Section: Situations Where Cr Tka Is Difficult To Performmentioning

confidence: 99%

“…However, many surgeons tend to select the type of prosthesis on the basis of their own training and experience 4). Some surgeons favor the use of a specific type of prosthesis, but others select one on an ad hoc basis 10). The selection of the type of prosthesis must be based on a great store of knowledge rather than on dogmatic preconceptions or rigid preferences 4)…”

mentioning

confidence: 99%

See 2 more Smart Citations

What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty

Song

Park

Bae³

2019

Clin Orthop Surg

Self Cite

View full text Add to dashboard Cite

There has been continuing debate about the superiority of cruciate-retaining (CR) total knee arthroplasty (TKA) versus posterior-stabilized (PS) TKA for obtaining knee joint stability with functional improvement. Many surgeons tend to select the type of prosthesis on the basis of their own training and experience. However, the selection must be based on a great store of knowledge rather than on the surgeon's preconceptions or preferences. CR TKA may not be feasible in certain settings: posterior cruciate ligament insufficiency, severe deformity, and history of trauma or surgery. The risk of conversion from a CR type prosthesis to a PS type prosthesis might be high in patients with severe flexion contracture, steep posterior slope, and small femoral component size. The above factors should be carefully considered for an appropriate selection of the type of prosthesis. The surgeon should have a clear understanding on the technical differences between CR and PS TKAs. The amount of distal femoral resection, femoral component size, and tibial slope are particularly crucial for successful TKA. Unless they are meticulously determined, stiffness or instability will ensue, which can be difficult to resolve afterwards. There was no notable difference in functional outcome, range of motion, kinematics, and survival rate between CR and PS TKAs in most previous studies. Strict adherence to surgical indications and solid understanding of differences in surgical principles might be more important than the selection of either a CR or PS prosthesis.

show abstract

Section: Situations Where Cr Tka Is Difficult To Performmentioning

confidence: 99%

Section: Situations Where Cr Tka Is Difficult To Performmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty

Song

Park

Bae³

2019

Clin Orthop Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…In conclusion, evaluating the tibial slope is a crucial phase in CR-TKR, since as recently explained by Dae Kyung Bae et al the steepness of the PTS is one of the main factors that requires the conversion to PS from a CR-type prosthesis [17].…”

Section: Posterior Tibial Slopementioning

confidence: 82%

Cruciate-Retaining Total Knee Arthroplasty

Calvisi¹,

Paglia²,

Ciprietti³

et al. 2018

Primary Total Knee Arthroplasty

View full text Add to dashboard Cite

The debate over the relative merits of substituting or retaining the posterior cruciate ligament (PCL) in total knee arthroplasty is still ongoing. The potential advantages of PCL preservation are a more natural femoral rollback, the presence of a structure critical for the proprioception, the maintenance of a native central stabilizer of the joint, and low shear stress on the bone-cement interface of the tibial component. Numerous retrospective studies of cruciate-retaining (CR) total knee arthroplasties have demonstrated consistently good clinical results and excellent intermediate and long-term survival. The main criticisms of the surgical technique are that the distal attachment of the PCL is vulnerable to injury and that balancing the PCL can be difficult; based on our experience, surgical tricks will be described to avoid the avulsion of the ligament and they will be discussed the main points to consider when you can find a discrepancy between flexion and extension stability. Based on the current evidence, we conclude that with a standardized technique, this type of implant should be preferred even in those cases where the sacrifice of the cruciate ligament seems to be the easiest way.

show abstract

“…Finally, 46 CR and 45 PS TKA patients were enrolled in this study (Table 1 ). In the PS group, 3 out of 45 patients were scheduled to receive CR-type TKA before surgery and were subsequently changed over to a PS-type TKA intraoperatively, owing to mismatched aspect ratios with the prosthesis size [ 11 ]. There were 35 men (38.4%) and 56 women (61.6%), with an average age of 69.4 ± 7.4 years (range, 48 to 85).…”

Section: Methodsmentioning

confidence: 99%

Mid-term survivorship of cruciate-retaining versus posterior-stabilized total knee arthroplasty using modular mini-keel tibial implants

et al. 2018

View full text Add to dashboard Cite

BackgroundReports of diverse outcomes in modular mini-keel tibial componentry for total knee arthroplasty (TKA) have raised concerns about early aseptic loosening. Cruciate-retaining (CR) prostheses, using mini-keel implants, have yet to be reported and compared to posterior-stabilizing (PS) designs.MethodsA retrospective, case-matched study of 91 consecutive TKAs (n = 46 CR; n = 45 PS prostheses), using modular mini-keel tibial componentry with a 45-mm drop down stem extension, was conducted. The Knee Society Score functional survey, radiographic analysis including alignment and periprosthetic radiolucency, TKA prosthesis longevity, and surgical complications were reported and compared between CR and PS groups.ResultsThe Knee Society Score at 5-year follow-up averaged 81.67 ± 11.97 and 80.12 ± 14.16 in the CR and PS groups, respectively (p = 0.29). The femorotibial angle averaged 5.85° ± 2.62° and 5.85° ± 3.27° valgus in the CR and PS groups, respectively (p = 0.60). The average tibial component angle was 0.46° ± 1.6° and 0.61° ± 1.3° varus in the CR and PS groups, respectively (p = 0.30); posterior inclination averaged 2.28° ± 2.36° and 1.93° ± 2.72° in the CR and PS groups, respectively (p = 0.51). Radiolucency was noted in 17 zones of the CR group and in 9 zones of the PS group (p = 0.24). Three TKAs required further surgery: one locking plate fixation for a periprosthetic tibial fracture (PS group) and two revision TKAs (one CR infection and one PS fracture).ConclusionModular mini-keel tibial components showed good reliability and results with both CR and PS prostheses in minimally invasive surgery TKA.

show abstract

Intraoperative factors affecting conversion from cruciate retaining to cruciate substituting in total knee arthroplasty

Abstract: IV.

Cited by 18 publications

References 42 publications

What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty

What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty

Cruciate-Retaining Total Knee Arthroplasty

Mid-term survivorship of cruciate-retaining versus posterior-stabilized total knee arthroplasty using modular mini-keel tibial implants

Contact Info

Product

Resources

About