Total Knee Arthroplasty: Posterior Stabilization vs. Posterior Cruciate Ligament Preservation. Clinical and Functional Evaluation
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Published:
Oct 17, 2024
Keywords:
Total knee arthroplasty, prosthetic design, posterior stabilization, cruciate retaining
Main Article Content
Abstract
Introduction: Despite the progress and numerous publications in recent years, the outcomes of posterior stabilized (PS) prosthetic designs versus those that preserve the posterior cruciate ligament (PCL) remain controversial.
Materials and Methods: This is a consecutive retrospective series involving 164 patients surgically treated by the same surgical team. Eighty patients received cruciate-retaining (CR) prostheses, and 84 received PS designs.
Results: The average age was 70 years. We identified 121 knees as grade 4 and 43 knees as grade 3 according to the Kellgren-Lawrence scale. The postoperative range of motion was 109.5° ± 10.5° in the CR group versus 110° ± 12° in the PS group (p = 0.50). No significant differences were found between the two groups in postoperative knee scores using the Knee Society Score (KSS): 84.7 ± 10 in the CR group versus 87 ± 10 in the PS group (p = 0.14). However, there was a significant difference in the functional score, with the CR group scoring 84 ± 12 versus 78.8 ± 17 in the PS group (p = 0.02). There were no significant differences in terms of patient satisfaction.
Conclusion: In our study, we found no significant differences in clinical evaluation, pain, or patient satisfaction between cruciate-retaining prosthetic designs and those with posterior stabilization. However, there was a significant difference in functional evaluation using the KSS, favoring the CR group.
Materials and Methods: This is a consecutive retrospective series involving 164 patients surgically treated by the same surgical team. Eighty patients received cruciate-retaining (CR) prostheses, and 84 received PS designs.
Results: The average age was 70 years. We identified 121 knees as grade 4 and 43 knees as grade 3 according to the Kellgren-Lawrence scale. The postoperative range of motion was 109.5° ± 10.5° in the CR group versus 110° ± 12° in the PS group (p = 0.50). No significant differences were found between the two groups in postoperative knee scores using the Knee Society Score (KSS): 84.7 ± 10 in the CR group versus 87 ± 10 in the PS group (p = 0.14). However, there was a significant difference in the functional score, with the CR group scoring 84 ± 12 versus 78.8 ± 17 in the PS group (p = 0.02). There were no significant differences in terms of patient satisfaction.
Conclusion: In our study, we found no significant differences in clinical evaluation, pain, or patient satisfaction between cruciate-retaining prosthetic designs and those with posterior stabilization. However, there was a significant difference in functional evaluation using the KSS, favoring the CR group.
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How to Cite
Nicolino, T., Astore, I., Costantini, J., & Carbó, L. (2024). Total Knee Arthroplasty: Posterior Stabilization vs. Posterior Cruciate Ligament Preservation. Clinical and Functional Evaluation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 498-506. https://doi.org/10.15417/issn.1852-7434.2024.89.5.2003
Section
Clinical Research
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References
1. Maloney WJ, Schurman DJ. The effects of implant design on range of motion after total knee arthroplasty. Clin
Orthop 1992;278:147-52. PMID: 1563146
2. Freeman MA, Railton GT. Should the posterior cruciate ligament be retained or resected in condylar no meniscal knee arthroplasty? The case for resection. J Arthroplasty 1998;3(Suppl):S3-S12. https://doi.org/10.1016/s0883-5403(88)80002-0
3. Morgan H, Battista V, Leopold SS. Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg
2005;13:515-24. https://doi.org/10.5435/00124635-200512000-00004
4. Parsley BS, Conditt MA, Bertolusso R, Noble PC. Posterior cruciate ligament substitution is not essential for
excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 2006;21(6 Suppl. 2):127-31.
https://doi.org/10.1016/j.arth.2006.05.012
5. Wünschel M, Leasure J, Dalheimer P, Kraft N, Müller O. Differences in knee joint kinematics and forces after
posterior cruciate retaining and stabilized total knee arthroplasty. Knee 2013;20(6):416-21.
https://doi.org/10.1016/j.knee.2013.03.005
6. Most E, Zayontz S, Li G, Otterberg E, Sabbag K, Rubash HE. Femoral roll-back after cruciate-retaining and
stabilizing total knee arthroplasty. Clin Orthop 2003;410:101-3. https://doi.org/10.1097/01.blo.0000062380.79828.2e
7. Mihalko WM, Krackow KA. Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop 1999;(360):243-50. https://doi.org/10.1097/00003086-199903000-00029
8. Lombardi AV, Mallory TH, Fada RA, Hartman JF, Capps SG, Kefauver CA, et al. An algorithm for the posterior
cruciate ligament in total knee arthroplasty. Clin Orthop 2001;(392):75-87. https://doi.org/10.1097/00003086-200111000-00010
9. Vinciguerra B, Pascarel X, Honton JL. [Results of total knee prostheses with or without preservation of the posterior cruciate ligament]. Rev Chir Orthop Reparatrice Appar Mot 1994;80(7):620-5. [En francés] PMID: 7638388
10. Stiehl JB, Voorhorst PE, Keblish P, Sorrells RB. Comparison of range of motion after posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 1997;10(4):216-20.
PMID: 9421597
11. Tanzer M, Smith K, Burnett S. Posterior-stabilized versus cruciate-retaining total knee arthroplasty: balancing the gap. J Arthroplasty 2002;17(7):813-9. https://doi.org/10.1054/arth.2002.34814
12. Straw R, Kulkarni S, Attfield S, Wilton TJ. Posterior cruciate ligament at total knee replacement. Essential, beneficial or a hindrance? J Bone Joint Surg Br 2003;85(5):671-4. PMID: 12892188
13. Jacobs W, Clement DJ, Wymenga AB. Retention versus removal of the posterior cruciate ligament in total knee
replacement. A systematic literature review within the Cochrane framework. Acta Orthopaedica 2005;76(6):757-68. https://doi.org/10.1080/17453670510045345
14. Li C, Dong M, Yang D, Zhang Z, Shi J, Zhao R, Wei X. Comparison of posterior cruciate retention and substitution in total knee arthroplasty during gait: a systematic review and meta-analysis. J Orthop Surg Res
2022;17:152. https://doi.org/10.1186/s13018-022-03047-y
15. Kaya O, Pihtili Tas N, Batur OC, Gonder N. Correlation of radiological and functional results while determining
total knee prosthesıs surgery indication in patients with osteoarthritis. Firat Med J 2023;28(3):237-40. Disponible
en: https://www.firattipdergisi.com/pdf/pdf_FTD_1378.pdf
16. Bercik MJ, Joshi A, Parvizi J. Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a metaanalysis. J Arthroplasty 2013;28:439-44. https://doi.org/10.1016/j.arth.2012.08.008
17. Hamai S, Okazaki K, Shimoto T, Nakahara H, Higaki H, Iwamoto Y. Continuous sagittal radiological evaluation
of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching
techniques. J Arthroplasty 2015;30:864-9. https://doi.org/10.1016/j.arth.2014.12.027
18. Yamamoto K, Nakajima A, Sonobe M, Akatsu, Yamada M, Nakagawa K. A comparative study of clinical outcomes between cruciate-retaining and posterior-stabilized total knee arthroplasty: A propensity score- matched cohort study. Cureus 2023;15(9):e45775. https://doi.org/10.7759/cureus.45775
19. Yagishita K, Muneta T, Ju YJ, Morito T, Yamazaki J, Sekiya I. High-flex posterior cruciate-retaining vs posterior
cruciate-substituting designs in simultaneous bilateral total knee arthroplasty. A prospective, randomized study. J
Arthroplasty 2012;27(3):368-74. https://doi.org/10.1016/j.arth.2011.05.008
20. Singleton N, Nicholas B, Gormack N, Stokes A. Differences in outcome after cruciate retaining and posterior
stabilized total knee arthroplasty. J Orthop Surg 2019;27(2):1-8. https://doi.org/10.1177/2309499019848154
21. Lützner J, Firmbach FP, Lützner C, Dexe Jl, Kirschner S. Similar stability and range of motion between cruciateretaining and cruciate-substituting ultracongruent insert total knee arthroplasty. Comparative study. Knee Surg Sports Traumatol Arthrosc 2015;23(6):1638-43. https://doi.org/10.1007/s00167-014-2892-x
Orthop 1992;278:147-52. PMID: 1563146
2. Freeman MA, Railton GT. Should the posterior cruciate ligament be retained or resected in condylar no meniscal knee arthroplasty? The case for resection. J Arthroplasty 1998;3(Suppl):S3-S12. https://doi.org/10.1016/s0883-5403(88)80002-0
3. Morgan H, Battista V, Leopold SS. Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg
2005;13:515-24. https://doi.org/10.5435/00124635-200512000-00004
4. Parsley BS, Conditt MA, Bertolusso R, Noble PC. Posterior cruciate ligament substitution is not essential for
excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 2006;21(6 Suppl. 2):127-31.
https://doi.org/10.1016/j.arth.2006.05.012
5. Wünschel M, Leasure J, Dalheimer P, Kraft N, Müller O. Differences in knee joint kinematics and forces after
posterior cruciate retaining and stabilized total knee arthroplasty. Knee 2013;20(6):416-21.
https://doi.org/10.1016/j.knee.2013.03.005
6. Most E, Zayontz S, Li G, Otterberg E, Sabbag K, Rubash HE. Femoral roll-back after cruciate-retaining and
stabilizing total knee arthroplasty. Clin Orthop 2003;410:101-3. https://doi.org/10.1097/01.blo.0000062380.79828.2e
7. Mihalko WM, Krackow KA. Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop 1999;(360):243-50. https://doi.org/10.1097/00003086-199903000-00029
8. Lombardi AV, Mallory TH, Fada RA, Hartman JF, Capps SG, Kefauver CA, et al. An algorithm for the posterior
cruciate ligament in total knee arthroplasty. Clin Orthop 2001;(392):75-87. https://doi.org/10.1097/00003086-200111000-00010
9. Vinciguerra B, Pascarel X, Honton JL. [Results of total knee prostheses with or without preservation of the posterior cruciate ligament]. Rev Chir Orthop Reparatrice Appar Mot 1994;80(7):620-5. [En francés] PMID: 7638388
10. Stiehl JB, Voorhorst PE, Keblish P, Sorrells RB. Comparison of range of motion after posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg 1997;10(4):216-20.
PMID: 9421597
11. Tanzer M, Smith K, Burnett S. Posterior-stabilized versus cruciate-retaining total knee arthroplasty: balancing the gap. J Arthroplasty 2002;17(7):813-9. https://doi.org/10.1054/arth.2002.34814
12. Straw R, Kulkarni S, Attfield S, Wilton TJ. Posterior cruciate ligament at total knee replacement. Essential, beneficial or a hindrance? J Bone Joint Surg Br 2003;85(5):671-4. PMID: 12892188
13. Jacobs W, Clement DJ, Wymenga AB. Retention versus removal of the posterior cruciate ligament in total knee
replacement. A systematic literature review within the Cochrane framework. Acta Orthopaedica 2005;76(6):757-68. https://doi.org/10.1080/17453670510045345
14. Li C, Dong M, Yang D, Zhang Z, Shi J, Zhao R, Wei X. Comparison of posterior cruciate retention and substitution in total knee arthroplasty during gait: a systematic review and meta-analysis. J Orthop Surg Res
2022;17:152. https://doi.org/10.1186/s13018-022-03047-y
15. Kaya O, Pihtili Tas N, Batur OC, Gonder N. Correlation of radiological and functional results while determining
total knee prosthesıs surgery indication in patients with osteoarthritis. Firat Med J 2023;28(3):237-40. Disponible
en: https://www.firattipdergisi.com/pdf/pdf_FTD_1378.pdf
16. Bercik MJ, Joshi A, Parvizi J. Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a metaanalysis. J Arthroplasty 2013;28:439-44. https://doi.org/10.1016/j.arth.2012.08.008
17. Hamai S, Okazaki K, Shimoto T, Nakahara H, Higaki H, Iwamoto Y. Continuous sagittal radiological evaluation
of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching
techniques. J Arthroplasty 2015;30:864-9. https://doi.org/10.1016/j.arth.2014.12.027
18. Yamamoto K, Nakajima A, Sonobe M, Akatsu, Yamada M, Nakagawa K. A comparative study of clinical outcomes between cruciate-retaining and posterior-stabilized total knee arthroplasty: A propensity score- matched cohort study. Cureus 2023;15(9):e45775. https://doi.org/10.7759/cureus.45775
19. Yagishita K, Muneta T, Ju YJ, Morito T, Yamazaki J, Sekiya I. High-flex posterior cruciate-retaining vs posterior
cruciate-substituting designs in simultaneous bilateral total knee arthroplasty. A prospective, randomized study. J
Arthroplasty 2012;27(3):368-74. https://doi.org/10.1016/j.arth.2011.05.008
20. Singleton N, Nicholas B, Gormack N, Stokes A. Differences in outcome after cruciate retaining and posterior
stabilized total knee arthroplasty. J Orthop Surg 2019;27(2):1-8. https://doi.org/10.1177/2309499019848154
21. Lützner J, Firmbach FP, Lützner C, Dexe Jl, Kirschner S. Similar stability and range of motion between cruciateretaining and cruciate-substituting ultracongruent insert total knee arthroplasty. Comparative study. Knee Surg Sports Traumatol Arthrosc 2015;23(6):1638-43. https://doi.org/10.1007/s00167-014-2892-x