Comparison of Cruciate-Sacrificing vs Posterior-Stabilized Total Knee Replacement Using a Contemporary Total Knee System

Thomas L Bernasek; T Kyle Stoops; Meera Gill; Corey Engel; Peter Simon

doi:10.1016/j.arth.2021.08.029

Comparison of Cruciate-Sacrificing vs Posterior-Stabilized Total Knee Replacement Using a Contemporary Total Knee System

J Arthroplasty. 2022 Jan;37(1):45-48. doi: 10.1016/j.arth.2021.08.029. Epub 2021 Sep 2.

Authors

Thomas L Bernasek¹, T Kyle Stoops², Meera Gill³, Corey Engel³, Peter Simon³

Affiliations

¹ Department of Orthopaedic Surgery, University of South Florida, Tampa, FL; Adult Reconstruction Hip and Knee, Florida Orthopaedic Institute, Temple Terrace, FL; Foundation for Orthopaedic Research and Education, Adult Reconstruction Hip and Knee, Temple Terrace, FL; Debartolo Center for Adult Reconstruction Research and Education, Attn: Thomas L. Bernasek, Temple Terrace, FL.
² Department of Orthopaedic Surgery, University of South Florida, Tampa, FL; Adult Reconstruction Hip and Knee, Florida Orthopaedic Institute, Temple Terrace, FL; Foundation for Orthopaedic Research and Education, Adult Reconstruction Hip and Knee, Temple Terrace, FL.
³ Foundation for Orthopaedic Research and Education, Adult Reconstruction Hip and Knee, Temple Terrace, FL.

PMID: 34563437
DOI: 10.1016/j.arth.2021.08.029

Abstract

Background: The use of highly conforming polyethylene tibial inserts in cruciate-retaining total knee arthroplasty (TKA) often requires posterior cruciate ligament (PCL) release/sacrifice for balancing (CS TKA). The CS TKA relies on the posterior capsule, collateral ligaments, and articular conformity without a cam or post to achieve stability. Using prospectively collected data we compared clinical outcomes of CS TKA to posterior-stabilized (PS) TKA utilizing a contemporary TKA system.

Methods: Sixty-nine consecutive CS TKAs were compared to 45 consecutive PS TKAs at 2-year minimum follow-up. CS knees were balanced with the PCL released. Preoperative/postoperative range of motion (ROM), Knee Society Scores (KSS), stair function, and squatting ROM were analyzed.

Results: At minimum 2-year follow up, CS and PS TKA demonstrated significant improvement in ROM (P < .001), KSS (Pain, P < .001; Function, P < .001), and KSS stair function (P < .001), with no revisions. There was no difference in preoperative to postoperative improvements for passive knee ROM (10° (0°-20°) vs 13° (5°-25°); P = .16), KSS Pain (34 (21-42) vs 38 (24-46); P = .22), KSS Function (35 (30-50) vs 35 (18-50); P = .34), and KSS stair function (10 (10-20) vs 10 (0-20); P = .37) for CS and PS TKA, respectively. CS TKA had higher squatting ROM (P = .02) at minimum 2-year follow-up compared to PS TKA.

Conclusion: Both PS and CS TKA provided significant improvement in clinical outcomes, with no differences in passive ROM, KSS, or stair function postoperatively. Our data support that with proper articular conformity and balancing, cruciate-retaining TKA in a PCL-deficient knee (CS TKA) is appropriate. This may be design specific and further prospective randomized studies are needed to corroborate these findings.

Keywords: comparison of cruciate sacrificing (CS) to posterior stabilized (PS) total knee replacement; cruciate sacrificing total knee replacement (CS); posterior stabilized total knee replacement (PS); total knee arthroplasty; total knee function; total knee outcome.

MeSH terms

Arthroplasty, Replacement, Knee*
Humans
Knee Joint / surgery
Knee Prosthesis*
Osteoarthritis, Knee* / surgery
Posterior Cruciate Ligament* / surgery
Range of Motion, Articular