Medial tibial bone resorption following total knee arthroplasty comparing a traditional with a kinematic design

Abstract

Background: New total knee prostheses are being designed to improve clinical outcome, survivorship and patient satisfaction following total knee arthroplasty (TKA). A new knee system was developed with improvements in patellofemoral joint, trochlear geometry, polyethylene formulation and tibial baseplate. Aim of this study was to compare the newer kinematic knee system with its existing predecessor knee system in terms of clinical outcome, revision rates, radiographic outcomes specifically medial tibial bone resorption.

Methods: The prospective matched-pair study included 88 TKA surgeries using newer kinematic design knee prostheses, performed between January 2015 and December 2016, out of which 82 patients were available for final follow-up. The control cohort of 82 traditional TKA prosthesis was matched in terms of age, gender and body mass index. All surgeries were performed by the single surgeon using medial parapatellar arthrotomy and posterior stabilized implants were used. Clinical outcomes were assessed using knee society score, range of motion (ROM), anterior knee pain and crepitation. Radiological examinations included recording of radiolucent lines and medial tibial bone resorption.

Results: At the 5-year follow-up, no significant differences were noted in terms of mean knee society score (93.3 ± 6.6 vs 94.2 ± 8.1), knee function score (88.5 ± 10.5 vs 89.1 ± 11.2) and ROM. The incidences of anterior knee pain and crepitation were lower in the newer group (8.5% vs 21.9% and 14.6% vs 32.9%, respectively) compared to the traditional prosthesis group. No cases of aseptic loosening were observed in either cohort. No significant difference was seen in terms of radiolucent lines (29.3% vs 26.8%) and medial tibial resorption (2.43% in each group) incidences.

Conclusions: At the 5 years follow-up no significant differences were noted between the two groups in terms of clinical and radiological outcomes, except the former proved to be better for anterior knee pain and crepitation.

Level of evidence: II.

Keywords: Attune knee prosthesis; Knee arthroplasty; PFC Sigma knee; Stress shielding.