No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial

Abstract

Purpose Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacriicing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCLsacriicing TKA. Methods Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no signiicant diferences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. Results There were no signiicant diferences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no signiicant diferences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and lexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). ConclusionThe use of UC or PS inserts in TKA did not afect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential diferences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacriicing the PCL in TKA. Level of evidence I.

Similar outcomes including maximum knee flexion between mobile bearing condylar-stabilised and fixed bearing posterior-stabilised prosthesis: a case control study

“…Three recent RCT’s have reported no difference in outcomes between PS and CS designed TKA. Specifically, Akti et al found no significant differences in KSS or isokinetic performance scores between prosthesis designs [ 7 ]. Furthermore, two of these RCT’s have demonstrated no difference in functional outcomes or ROM intra-operatively, at 1 [ 24 ] and 5-year follow-up [ 35 ].…”

“…ROM 112.2° SF-36 physical 42.3 OKS 42 UCLA 4 Intra-op. ROM 115.1° SF-36 physical 37.9 OKS 41 UCLA 4 Akti (2021) [ 7 ] RCT 33 (fixed) 33 PS (fixed) Vanguard 1 year ROM 128.7° KSS ‘no difference’ ROM 133.9° KSS ‘no difference’ Hinarejos (2021) [ 30 ] RCT CS Triathlon* (29) CS U2** (30) PS Triathlon* (29) PS U2** (29) Triathlon and U2 1 year ROM* 112.8° ROM** 109.3° KSS total* 171.5 KSS total** 172.2 ROM* 116.5° ROM** 113.5° KSS total* 178.1 KSS total** 169.7 Kim (2021) [ 31 ] RCT 50 (fixed) 50 PS (fixed) Persona 2 years ROM 126.5° WOMAC 14.3 KSS function 110.8 KSS pain 52.2 ROM 127.4° WOMAC 14.5 KSS function 108.5 KSS pain 51.2 Han (2020) [ 18 ] RCT 34 (fixed) 34 PS (fixed) Triathlon 5 years ROM 115° Knee society knee 95 ROM 124° Knee society knee 93 Stirling (2019) [ 32 ] Retrospective cohort 54 (fixed) 364 CR (fixed) Triathlon 1 year Pain VAS 64.5 OKS 33.2 Pain VAS 70.6 OKS 34.6 Jang (2019) [ 20 ] RCT 45 (fixed) 45 PS (fixed) Vanguard 2 years ROM 130.1° KSS 157.1 WOMAC 27.1 129.9° KSS 156.5 WOMAC 26.6 Song (2017) [ 33 ] RCT 38 (fixed) 38 CR (fixed) e.motion 3 years ROM 130.8° HSS 94.3 WOMAC 25.2 KS Knee Society 92.3 ROM 128.7° HSS 93.0 WOMAC 24.0 KS Knee Society 89.6 Fritzsche (2017) [ …”

Cruciate-Retaining vs Posterior-Stabilized Antibiotic Cement Articulating Spacers for Two-Stage Revision of Prosthetic Knee Infection: A Retrospective Cohort Study

“…Song et al reported no differences in mediolateral or anteroposterior laxity between UC TKA and CR TKA in stress radiographs at full extension, and concluded that UC inserts can be a good option in TKA without bony box cuts when the PCL is damaged during an operation [50]. Moreover, UC TKA is a safe alternative to PS TKA and similarly has good clinical outcomes if cruciate substitution is necessary in randomized control trials and propensity score-matched analyses [46,51,52]. Furthermore, the joint perception and isokinetic performance were similar between UC TKA and PS TKA [52,53].…”

“…Moreover, UC TKA is a safe alternative to PS TKA and similarly has good clinical outcomes if cruciate substitution is necessary in randomized control trials and propensity score-matched analyses [46,51,52]. Furthermore, the joint perception and isokinetic performance were similar between UC TKA and PS TKA [52,53]. However, with the use of a navigation system intraoperatively, UC TKA was found to have more sagittal laxity with less femoral rollback and knee flexion than PS TKA [53][54][55].…”

Comparative Analysis of Contemporary Fixed Tibial Inserts: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

“…10 Drawbacks to PS knees include additional bone resection for the cam and post mechanism, which increases the risk of condylar fracture. 11 In addition, post failure and patellar clunk syndrome 12 are also potential drawbacks.…”