Comparison of the Clinical Results of Patients who Underwent PCL-retaining and PCL-substituting Total Knee Arthroplasty

Zekeriya Okan Karaduman

J Clin Exp Invest 2020;11(1):em00734.

https://doi.org/10.5799/jcei/7590

Article views: 369 Article downloads: 120

OPEN ACCESS

Download Full Text (PDF)

Abstract

Objective: This study aimed to retrospectively evaluate patients undergoing total knee arthroplasty (TKA) and compare clinical results of patients with posterior cruciate ligament (PCL)-retaining and PCL-substituting TKA.
Method: The clinical results of 60 patients who underwent TKA (30 PCL retaining and 30 PCL substituting) at Düzce University Faculty of Medicine Hospital between September 2014 and September 2016 were evaluated and compared. The clinical results were evaluated using knee scores and knee functional scores according to the American Knee Society Criteria.
Results: The mean postoperative flexion angles were 110.33° ± 5.71° (100°–120°) in the PCL-substituting group and 102.50° ± 5.69° (90°–110°) in the PCL-retaining group, the postoperative knee scores were 90.20 ± 5.16 and 84.07 ± 5.87, respectively, and postoperative knee functional scores were 80.60 ± 7.86 and 78.17 ± 7.25, respectively. Knee scores were significantly different between the groups (P < 0.001). There was no significant difference between the groups in terms of knee functional scores.
Conclusion: Compared with the literature, knee scores of the PCL-substituting group yielded significant results, whereas the knee functional scores were similar to those of the PCL-retaining group. The results reported here indicate that clinical outcomes and survival are not different for either surgical option, and it is possible to achieve good results in both groups when appropriate soft tissue balance is achieved.

Keywords

knee osteoarthritis, posterior cruciate ligament-retaining total knee arthroplasty, posterior cruciate ligament-substituting total knee arthroplasty, total knee arthroplasty

References

  • Kurtz S, Ong K, Lau E, Mowat F, Halpem M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am., 2007;89:780.
  • Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27, 372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand., 2000;71:262-7.
  • Wylde V, Blom AW, Whitehouse SL, Taylor AH, Pattison GT, Bannister GC. Patient-Reported Outcomes after Total Hip and Knee Arthroplasty. The Journal of Arthroplasty, 2009; 24: 209-16.
  • Lombardi AV, Mallory TH, Fada RA, Hartman JF, Capps SG, Kefauver CA, Adams JB. An algorithm for the posterior cruciate ligament in total knee arthroplasty. Clin Orthop Relat Res., 200;(392):75-87.
  • Mihalko WM, Krackow KA. Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop Relat Res., 1999;(360):243-50.
  • Swanik CB, Lephart SM, Rubash HE. Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone Joint Surg Am., 2004;86-A:328-34.
  • Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ. Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res., 1998;(356):39-46.
  • Dennis DA, Komistek RD, Mahfouz MR, Walker SA, Tucker A. A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res., 2004;428(11):180-9.
  • Baldini A, Scuderi GR, Aglietti P, Chalnick D, Insall JN. Flexion-extension gap changes during total knee arthroplasty: effect of posterior cruciate ligament and posterior osteophytes removal. J Knee Surg., 2004;17:69-72.
  • Jacobs WC, Clement DJ, Wymenga AB. Retention versus removal of the posterior cruciate ligament in total knee replacement. Act Orth., 2005;76(6):757-68.
  • Insall JN, Henry DC. Historic Development, Classification, and Characteristics of Knee Prostheses. Surgery of the Knee. 3rd ed. New York: Churchill Livingtone., 2001;p:1516-47.
  • Vessely MB, Whaley AL, Harmsen WS, et al. The Chitranjan Ranawat Award: long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res., 2006;452:28-34.
  • Kelly MA, Clarke HD. Long-term results of posterior cruciatesubstituting total knee arthroplasty. Clin Orthop Relat Res., 2002;404:51-7.
  • Becker MW, Insall JN, Faris PM. Bilateral total knee arthroplasty: one cruciate retaining and one cruciate substituting. Clin Orthop Relat Res., 1991;271:122-4.
  • Jiang C, Liu Z, Wang Y, Bian Y, Feng B, Weng X. Posterior Cruciate Ligament Retention versus Posterior Stabilization for Total Knee Arthroplasty: A Meta-Analysis. PLoS One. 2016;29 11(1):e0147865. doi: 10.1371/journal.pone.0147865.
  • Chaudhary R, Beaupré LA, Johnston DW. Knee range of motion during the first two years after use of posterior cruciate-stabilizing or posterior cruciate-retaining total knee prostheses. A randomized clinical trial. J Bone Joint Surg Am., 2008; 90(12): 2579-86. doi: 10.2106/JBJS.G.00995.
  • Engh GA. Is long-term survivorship really significantly better with cruciate-retaining total knee implants? Commentary on an article by Abdel MP et al.: “Increased Long-Term survival of Posterior Cruciate-Retaining Versus Posterior Cruciate-Stabilizing Total Knee Replacements”. J Bone Joint Surg (Am)., 2011;93(22): e136 1–2.
  • Marczak D, Kowalczewski J, Okoń T, Synder M, Sibiński M. An evaluation of the posterior cruciate ligament function in total knee arthroplasty with regard to its morphology and clinical properties. Folia Morphol (Warsz)., 2017;76(1):94-9. doi: 10.5603/FM.a2016.0047.
  • Maruyama S, Yoshiya S, Matsui N, Kuroda R, Kurosaka M. Functional comparison of posterior cruciate-retaining versus posterior stabilized total knee arthroplasty. J Arthroplasty, 2004;19:349-53.
  • Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M. In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty, 2005;20:777-83.
  • Bolanos AA, Colizza WA, McCann PD, Gotlin RS, Wootten ME, Kahn BA, Insall JN. A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties. J Arthroplasty, 1998;13:906-15.
  • Hofmann AA, Tkach TK, Evanich CJ, Camargo MP. Posterior stabilization in total knee arthroplasty with use of an ultracongruent polyethylene insert. J Arthroplasty, 2000;15:576-83.
  • Sathappan SS, Wasserman B, Jaffe WL, Bong M, Walsh M, Di Cesare PE. Midterm results of primary total knee arthroplasty using a dished polyethylene insert with a recessed or resected posterior cruciate ligament. J Arthroplasty, 2006;21:1012-6.
  • Van Den Boom LG, Halbertsma JP, van Raaij JJ, Brouwer RW, Bulstra SK, van den Akker-Scheek I. No difference in gait between posterior cruciate retention and the posterior stabilized design after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22(12):3135-41. doi: 10.1007/s00167-014-3215-y.
  • Kim YH, Choi Y, Kwon OR, Kim JS. Functional outcome and range of motion of high-flexion posterior cruciate-retaining and high-flexion posterior cruciate-substituting total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am., 2009;91(4):753-60. doi: 10.2106/JBJS.H.00805.
  • Thippanna RK, Mahesh P, Kumar MN. PCL-retaining versus PCL-substituting TKR - Outcome assessment based on the “forgotten joint score”. J Clin Orthop Trauma, 2015; 6(4): 236-9. doi: 10.1016/j.jcot.2015.04.009.
  • Arabori M, Matsui N, Kuroda R, Mizuno K, Doita M, Kurosaka M, Yoshiya S. Posterior condylar offset and flexion in posterior cruciate-retaining and posterior stabilized TKA. J Orthop Sci., 2008;13(1):46-50. doi: 10.1007/s00776-007-1191-5.

Citation

Karaduman ZO. Comparison of the Clinical Results of Patients who Underwent PCL-retaining and PCL-substituting Total Knee Arthroplasty. J Clin Exp Invest. 2020;11(1):em00734. https://doi.org/10.5799/jcei/7590