Jörg Lützner1, Franziska Beyer2, Julian Dexel3, Hagen Fritzsche2, Cornelia Lützner2, Stephan Kirschner4. 1. University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany. Joerg.Luetzner@uniklinikum-dresden.de. 2. University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany. 3. Forum Gesundheit Dresden MVZ, Dresden, Germany. 4. St. Vincentus-Kliniken, Karlsruhe, Germany.
Abstract
PURPOSE: The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior stabilized (PS) total knee arthroplasty (TKA). This study investigated range of motion (ROM), stability and patient-reported outcome (PRO) in UC and PS TKA. We hypothesized better knee flexion with the PS design but no difference in stability and PRO between UC and PS TKA. METHODS: A randomized controlled study was performed. One hundred and twenty-seven patients were included, 63 with an UC and 64 with a PS TKA (Columbus, Aesculap, Tuttlingen, Germany). Intraoperative stability and range of motion was measured with the use of a navigation system. Patients were assessed before surgery, 3 months and 1 year postoperatively. RESULTS: There was no difference in ROM between both groups, neither intraoperatively nor at follow-up. There was 5 mm less sagittal translation at 90° of knee flexion (p < 0.001) and more posterior femoral rollback during knee flexion in the PS TKA. Axial rotation between extension and knee flexion was reduced by both designs. UC TKA was 7 min faster (p = 0.001). At the one-year follow-up, the Knee Society Score was similar in both groups, the Oxford Knee Score demonstrated better results in the UC TKA group (p = 0.048). CONCLUSION: Increased intraoperative sagittal translation and reduced posterior femoral rollback during knee flexion of UC TKA seem to have no negative influence on short-term clinical outcome. Therefore, UC TKA seems to be a practical alternative to the established PS TKA for substitution of the PCL. This might be especially interesting for surgeons who do not always substitute the PCL. LEVEL OF EVIDENCE: I.
RCT Entities:
PURPOSE: The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior stabilized (PS) total knee arthroplasty (TKA). This study investigated range of motion (ROM), stability and patient-reported outcome (PRO) in UC and PS TKA. We hypothesized better knee flexion with the PS design but no difference in stability and PRO between UC and PS TKA. METHODS: A randomized controlled study was performed. One hundred and twenty-seven patients were included, 63 with an UC and 64 with a PS TKA (Columbus, Aesculap, Tuttlingen, Germany). Intraoperative stability and range of motion was measured with the use of a navigation system. Patients were assessed before surgery, 3 months and 1 year postoperatively. RESULTS: There was no difference in ROM between both groups, neither intraoperatively nor at follow-up. There was 5 mm less sagittal translation at 90° of knee flexion (p < 0.001) and more posterior femoral rollback during knee flexion in the PS TKA. Axial rotation between extension and knee flexion was reduced by both designs. UC TKA was 7 min faster (p = 0.001). At the one-year follow-up, the Knee Society Score was similar in both groups, the Oxford Knee Score demonstrated better results in the UC TKA group (p = 0.048). CONCLUSION: Increased intraoperative sagittal translation and reduced posterior femoral rollback during knee flexion of UC TKA seem to have no negative influence on short-term clinical outcome. Therefore, UC TKA seems to be a practical alternative to the established PS TKA for substitution of the PCL. This might be especially interesting for surgeons who do not always substitute the PCL. LEVEL OF EVIDENCE: I.
Entities:
Keywords:
Deep dished insert; Range of motion; Results; Stability; TKA; TKR; Ultracongruent insert
Authors: J-N Argenson; S Boisgard; S Parratte; S Descamps; M Bercovy; P Bonnevialle; J-L Briard; J Brilhault; J Chouteau; R Nizard; D Saragaglia; E Servien Journal: Orthop Traumatol Surg Res Date: 2013-05-02 Impact factor: 2.256
Authors: G J P Geijsen; P J C Heesterbeek; G van Stralen; P G Anderson; A B Wymenga Journal: Knee Surg Sports Traumatol Arthrosc Date: 2013-05-16 Impact factor: 4.342