Midterm Results of Primary Total Knee Arthroplasty Using a Dished Polyethylene Insert with a Recessed or Resected Posterior Cruciate Ligament (original) (raw)
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Primary total knee replacement using dished polyethylene with resected posterior cruciate ligament
International Journal of Research in Orthopaedics, 2021
Background: The choice between preserving, sacrificing or substituting the posterior cruciate ligament (PCL) is always a controversial topic in total knee replacement (TKR). Dished polyethylene insert with PCL resection enables correction of the commonly present fixed flexion and varus deformities. Additionally, the risk of premature wear of polyethylene is less because of the confirming articular geometry between the femoral and tibial component.Methods: This is a retrospective study in which we studied 120 knees in 95 consecutive patients undergoing primary TKR by the senior author at our institute. We used TKR system with dished metal backed polyethylene tibial component. PCL resection was performed in all cases. Pre-operative and post-operative functional assessment were done using knee society clinical scores and Western Ontario and McMaster universities osteoarthritis index (WOMAC). All radiographs were assessed using the knee society Roentgenographic scoring system (KSRES). S...
Cruciate-Retaining vs Posterior-Substituting Inserts in Total Knee Arthroplasty
The Journal of Arthroplasty, 2013
Despite clinical success, it is unclear which one, posterior-substituting (PS) or cruciateretaining (CR) insert, has superior functional outcomes or longevity. We compared the collected results from 2 institutional review board-approved, multicenter, prospective observational studies following CR (412) and PS inserts (328). Participants were evaluated preoperatively, at 6 weeks, at 3 months, and at 1 and 2 years regarding pain, motion, function (Knee Society Score, Krackow Activity Score, Short Form-36), and procedure variables such as anesthesia and preoperative/ perioperative/postoperative complications. Implant longevity was recorded at the 2-year follow-up. Improvement was observed within each group; however, there was no difference between groups in terms of pain, motion, or function at any end point. Two-year survival rate was higher than 95%. A higher incidence of wound hematoma was observed in the PS group. Both inserts can be used expecting satisfactory outcomes and high survival rates at 2 years.
Cureus, 2020
Background: Posterior-stabilized (PS) total knee arthroplasty (TKA) poses problems such as the need for intercondylar notch bone resection as well as cam and post wear and patella clunk. Owing to its heightened anterior profile, an ultracongruent polyethylene insert prevents the excessive posterior translation of tibia in the case of a deficient or scarified posterior cruciate ligament (PCL). This study aimed to determine whether an ultracongruent insert provides satisfactory clinical and functional outcomes and midterm survival benefits. Methods: Based on the reviewed medical records of 200 patients, 240 primary TKA cases involving the use of Sigma Curved Plus (DePuy International, Ltd., Leeds, UK) ultracongruent insert were retrospectively enrolled in this study. Follow-up data were used to evaluate the clinical and radiological outcomes and to conduct a Kaplan-Meier survival analysis. Results: The mean follow-up duration for 224 knees was 5.8 years (range 5-6.5 years). A revision was made due to infection in two patients and due to periprosthetic fractures in two other patients. The mean knee flexion improved from 101.97° ± 9.43° (range 85°-125°) to 125.75° ± 9.58° (range 100°-140°) at the final follow-up. The mean Knee Society score improved from 43.1 ± 9.76 to 88.3 ± 3.2, and the function score improved from 44.95 ± 7.26 to 90.16 ± 3.71. None of the patients showed radiographic loosening of either insert component, but 22 (5%) patients showed radiolucent lines (<2 mm). The Kaplan-Meier analysis showed that the five-year survival of the insert with an endpoint of revision for any reason was 98.1% (confidence interval, CI, 95.7-99.6%). Conclusion: The Sigma Curved Plus insert showed a low failure rate with good clinical, functional, and midterm survival outcomes in comparison to standard outcomes reported in earlier studies. Further followup studies are warranted to determine whether the insert's performance is maintained in the long term.
Clinical Biomechanics, 2011
Backgrounds: Deficiencies in contemporary posterior crucitate retaining knee included inadequate femoral rollback and insufficient tibial rotation. Current study attempted to restore normal femoral rollback and tibial rotation to facilitate in knee flexion/extension and to achieve appropriate posture at deep knee bending after total knee arthroplasy by mimicking the morphology of convexly lateral tibial plateau of intact knee. Methods: Computational simulation was utilized to analyze motion of three-dimensional knee models, including intact, traditionally symmetrical posterior crucitate retaining and newly anatomic-like posterior crucitate retaining knees. Solid bones, attachments of ligaments and tendons of simulation models were reconstructed by magnetic resonance images of the subject. According to the representative literature, the distal femur was modeled to rotate about the specific axes and the motion of the proximal tibial was unconstrained except for the flexion/extension. Movements of the medial/lateral condyles and tibial rotation were recorded and analyzed. Findings: The newly anatomic-like posterior crucitate retaining knee improved the posterior movement of lateral condyle and tibial internal rotation significantly during full range of flexion. Compared with traditionally symmetrical posterior crucitate retaining knee, the improvements displayed by newly developed posterior crucitate retaining knee in posterior movement of lateral condyle and tibial internal rotation were 11.2 mm and 9.3°at full flexion, respectively. Interpretation: The newly anatomic-like posterior crucitate retaining knee demonstrated that mimicking the morphology of convexly lateral tibial plateau can be expected to restore normal knee kinematics.
Journal of Orthopaedics, 2021
Total knee designs have evolved to allow more motion with compromising stability. The purpose of this study is to compare standard congruency and anterior lipped liners' effects on patient reported outcomes after TKA. 68 patients were retrospectively reviewed, and their SF-12 and KOOS scores were assessed preoperatively and one year post-operatively. Two-sample t-tests were used to compare differences between groups. The CVD design had a statistically significant greater improvement in KOOS-Pain compared to CVD+. No statistical difference was observed in the outcomes. The results may suggest that higher congruency designs lead to less physiological joint kinematics and pain.
Advances in orthopedics, 2014
Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixedbearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96±7) and function (92±13) scores and radiographic outcomes were good to excellent for 84% of patients after 5-10 years in vivo. Range of motion averaged 124 ∘ ±9 ∘ , with 126 knees exhibiting ≥ 120 ∘ flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5 ∘ more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.
Knee Surgery, Sports Traumatology, Arthroscopy
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Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
The aim of the study was to compare the functional outcome of posterior cruciate ligament (PCL) substituting primary knee arthroplasty with primary knee arthroplasty using ultra-congruent (UC) tibial articular insert after complete release of PCL. The study aimed to compare the stability of the knee joint after PCL sacrifice for degenerative arthritis of the knee. Methods: This was a prospective, randomized, double blind and single-center study. After approval by the Institutional Ethical Committee, 80 patients, 40 in each group ('UC' and posterior stabilized, 'PS') of either sex, aged between 60 and 80 years and willing to participate in the study were included in the study. Patients underwent primary knee arthroplasty with either UC or PS implants using simple random sampling method. Each patient was followed up at 6 months, 1 year and between 5 & 7 years postoperatively and the functional results were assessed using Modified Knee Society Score (Insall modification-1993). Results: Around 73% of the patients were women and the average age was 67 years in line with the known literature confirming increased incidence of osteoarthritis requiring total knee arthroplasty in women and older individuals. There was a significant relief in pain and improvement in stair climbing ability after surgery. There was a reduction in flexion contractures, medial/lateral instability and anterior-posterior instability postoperatively. The improvement in range of motion was significant in the UC group as compared to PS group. Similarly, the total score was significantly higher in the UC group as compared to PS. Conclusion: If functional outcomes are taken into consideration, UC prosthesis is better than the PS prosthesis. Further randomized and doubleblinded clinical trials with larger sample size and longer duration follow-up need to be conducted to validate the findings.
Cruciate Substituting Implants in Primary Total Knee Arthroplasty
Advances in Orthopedics, 2022
The use of cruciate substituting (CS) total knee replacement has been increasing in popularity. There are numerous factors that have likely contributed to this expansion. The CS philosophy incorporates the ease of use commonly cited by advocates of the posterior stabilized (PS) total knee design with the bone preservation associated with a cruciate retaining (CR) design. The ultra-congruent highly cross-linked polyethylene liner increases stability without an appreciable change in wear. Furthermore, balancing the flexion and extension gaps does not require “titrating” the posterior cruciate ligament, improving the user-friendliness. This paper reviews the nuances of this implant design compared to PS and CR designs as well as provides surgical technique recommendations/considerations.
International Journal of Orthopaedics Sciences
Background: The role of posterior cruciate ligament (PCL) conservation and the choice of the level of constraint of polyethylene insert in total knee arthroplasty (TKA) are still debated. The use of anterior stabilized bearing has been associated with clinical success in a limited number of studies. We have used anterior stabilized bearing and studied its impact in case of lose or deficient PCL. Material and Methods: A prospective study of 100 total knee arthroplasty to evaluate the impact of anterior stabilized bearing in partially or completely released PCL. Outcomes were measured with Knee Society scores, complications, revision TKA, and survival. Radiographs were analyzed for component alignment and evidence of loosening. Results: Total 100 TKA were performed in seventy patients comprising of 53 females and 17 males. Mean follow-up in the study was 2.4 years (2-3 years). Knee Society Score for clinical and function scale increased from means of 54.2 (range, 36-68) and 48.6 (range, 33-62) preoperatively to 93.1 (range, 82-100) and 90.4 (range, 76-100) at final follow-up respectively. Results were good or excellent in 93.5 % of knees (79 excellent, 8 good); 6 patients reported fair results. Conclusion: The use of an anterior stabilized (AS) bearing for PCL substitution has comparable clinical and radiographic results to traditional Cruciate Retaining (CR) and Posterior Stabilized (PS) TKA. These results suggest that this approach is an effective method to achieve stability without the PCL in primary TKA with the advantage of bone conservation.