Total knee replacement with retention of both cruciate ligaments

Abstract

We report on the long-term results of 163 bicruciate-retaining Hermes 2C total knee replacements in 130 patients at a mean follow-up of 22.4 years (20.3 to 23.5). Even when the anterior cruciate ligament had a partially degenerative appearance it was preserved as long as the knee had a normal anterior drawer and Lachman's test pre-operatively. The description and surgical technique of this minimally constrained prosthesis were published in 1983 and the ten-year clinical results in 1999. A total of 12% of the knees (20 of 163) in this study were revised because of wear of the polyethylene tibial insert. Excellent stability was achieved and the incidence of aseptic component loosening was 4.3% (seven of 163). The survival rate using revision for any reason as the endpoint was 82% (95% confidence interval 76.2 to 88.0). Although this series included a relatively small number of replacements, it demonstrated that the anterior cruciate ligament, even when partially degenerated at the time of TKR, remained functional and provided adequate stability at a long-term follow-up.

Higher Frequency of Reoperation With a New Bicruciate-retaining Total Knee Arthroplasty

“…However, the overall risk of revision was also higher in the BCR group (5% versus 1%). In the longest reported followup study on BCR knees, Sabouret et al [23] reported a survival rate of 82% with revision surgery as the endpoint.…”

“…The implant failures included 10 with loose tibial implants. Neither Sabouret et al [24] nor Townley [23,26] commented on the early complication or reoperation nor the potential for a learning curve effect early in the operative experience.…”

“…Older studies on BCR TKA have primarily focused on implant survivorship and surgeon-reported outcomes [7,23,26] rather than on patient-reported outcomes, and so comparisons are difficult to make. Pritchett [21] demonstrated strong patient preference for a BCR (89%) compared with other TKA designs in patients who underwent staged bilateral TKA.…”

“…Further concerns have been raised with respect to tibial baseplate design [9], wear of polyethylene components [23], fracture of the bony tibial eminence [9], and ability to effectively correct knee deformity [6,29]. Alterative implant designs such as the posterior cruciateretaining (CR) implant have established track records with regard to clinical efficacy, implant survivorship, and patient-reported outcomes [16].…”

Bicruciate-retaining total knee arthroplasty, a promising technology, that’s not quite there

“…When the BCR was compared to the CR in 91 patients, seven patients did not express a preference, 17 (18.7%) felt the CR implant was better and 67 (73.6%) felt that the BCR was better (5). When evaluating long-term results of a BCR design, survival rate using revision for any reason as the endpoint was 82% at 22.4 years (6).…”