Comparisonof early joint amnesia degree after posterior cruciate-retaining and posterior stabilized total knee arthroplasty / 中国组织工程研究

BACKGROUND: Clinical long-term follow-up showed that there is no obvious difference in knee range of motion, 10-15 year prosthesis survival rate, and main clinical manifestations after replacement of posterior cruciate-retaining and posterior stabilized prostheses. However, the debate over the superiority and inferiority of the two knee prostheses remains. OBJECTIVE: To compare the differences of early functional recovery of patients with unilateral knee osteoarthritis after posterior cruciate-retaining and posterior stabilized prosthesis replacement. METHODS: A total of 60 patients with knee osteoarthritis admitted to the First Affiliated Hospital of Anhui Medical University from July 2018 to September 2019 were selected, including 13 males and 47 females, aged 46-83 years old. Of them, 30 patients received posterior cruciate-retaining prosthesis replacement, and 30 patients received posterior stabilized prosthesis replacement. At 3 months after operation and at the last follow-up, joint amnesia score, knee function HSS score, visual analogue scale score, and knee motion range were assessed. The study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Sixty patients were followed up for 5-16 months, and no complications such as periprosthetic infection, loosening, dislocation, or stiffness occurred during the follow-up. (2) At 3 months after surgery and at the last follow-up, joint amnesia score, HSS scores, visual analogue scores, and knee motion range were not significantly different between the two groups (P > 0.05). (3) The results showed that joint amnesia score was not significantly different in early stage after the posterior cruciate-retaining and posterior stabilized prosthesis replacement for unilateral knee osthoarthritis.

The Use of PS or CR Models is not Sufficient to Explain the Differences in the Results of Total Knee Arthroplasty. Study of Interactions.

Aim: The study of results of Total Knee Arthroplasty based exclusively on the use of models Posterior stabilized (PS) or Cruciate retaining (CR) may be insufficient if we do not analyse other factors. Our objective is to analyse the interaction of certain factors as age, sex, BMI, prior deformity and use of navigation on the follow-up. Materials and Methods: Multicenter study of 415 Total Knee Arthroplasty (TKA). In 298 cases, the CR model was implanted and the PS in 117. The results were evaluated with the scales WOMAC, AKS and SF-12 v2. The average age of the series was 71 years (SD 7.8). The mean BMI was 31.7 (SD 4). In 294 cases, the frontal deformity of the mechanical axis of the knee was greater than 3°, particularly varus. Surgical navigation was used in 38.5% of patients as a helper in the implant of arthroplasty. Results: PS implanted joints demonstrated better results in all subscales than CR implanted joints. However,the study of the interaction between type of technique and preoperative deformity, sex, age, and BMI, showed that prior deformity and BMI influenced more on results than the use of one model or another. Navigation improved the results in the three scales, although these cases started with lower scores. Conclusion: Analysis of results of TKAs based exclusively on the use of PS or CR models is insufficient. Characteristics of the patient, previous deformity and navigation aid influence more on the results than using one model or another.

Mid-term Results of Single-Radius Cruciate Retaining Total Knee Arthroplasty: Minimum 5 Year Follow-up

PURPOSE: The single-radius design of the knee implant was introduced to improve the results of total knee arthroplasty (TKA) by reducing maximum extensor forces, and it also represents more physiologic quadriceps force pattern, which could have a positive effect on knee function after TKA. We studied mid-term results of single-radius designed cruciate retaining (CR) TKA. MATERIALS AND METHODS: We analyzed the functional improvement and radiological osteolytic pattern after TKA using the single-radius Scorpio CR prosthesis. TKA was performed on 102 knees. The mean follow-up period was 73.8 months. For clinical assessment, the range of motion (ROM), Harris hip score, and functional outcome score were obtained preoperatively and at last follow-up. RESULTS: The average ROM was 100.2degrees preoperatively and 121.7degrees at last follow-up. The average knee score was 59.2 points preoperatively and 92.9 points at last follow-up. The average functional outcome score was improved from 51.9 points preoperatively to 85.4 points at last follow-up. Radiolucency was observed in four knees but all were non-progressive lesions smaller than 2 mm. CONCLUSIONS: The clinical outcome of TKA using the single-radius CR prosthesis was good during the mid-term follow-up and the incidence of osteolysis was very rare.

Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

PURPOSE: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. MATERIALS AND METHODS: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. RESULTS: After the 2-year postoperative period, the mean range of motion was 131degrees in the CR-Flex group and 133degrees in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2+/-9.1 points) than in the PS-Flex group (11.9+/-9.6 points); however, this difference was not statistically significant (p=non-significant). CONCLUSION: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.

Outcomes of the Different Types of Total Knee Arthroplasty with the Identical Femoral Geometry

PURPOSE: There are controversies around the role of the posterior cruciate ligament and the effect of design modifications for high flexion in total knee arthroplasty (TKA). So, we compared the clinical outcomes of the cruciate retaining (CR), posterior stabilized (PS), and high flexion posterior stabilized (F-PS) designs in TKA with identical femoral geometry. MATERIALS AND METHODS: One hundred seventy nine knees with 3 different types of prostheses after a minimum 5-year follow-up were enrolled in this retrospective study: 45 with CR, 40 with PS and 94 with F-PS. The mean ages of these groups were 65.7, 67.2, and 67.5, and the mean durations of follow-up were 8.1, 8.0, and 6.8 years, respectively. We compared the range of motion, functional outcomes, and radiographic measurements at the 2-year follow-up and last follow-up. RESULTS: The maximal flexion angle was significantly lower in the CR group than the F-PS group at the 2-year follow-up. However, there was no significant difference at the last follow-up. Functional outcomes and survival rate of the three groups were similar at the last follow-up. CONCLUSIONS: Three different types of TKAs (CR, PS and F-PS) with identical femoral geometry showed similar mid-term outcomes with regard to the range of motion, functional outcomes and survival rate.

Comparison of Posterior-Cruciate Retaining versus Substituting P.F.C. Total Knee Arthroplasty (A Randomized Study) / 대한정형외과학회잡지

PURPOSE: To compare the functional results of posterior cruciate-retaining (PCR) and posterior sub- stituting (PS) replacement in patients undergoing primary total knee arthroplasty (TKA) for osteoarthritis. MATERIALS AND METHODS: A randomized controlled study was carried out to compare the clinical and radiological outcomes of PCR and PS primary P.F.C.(R) TKA. One hundred and sixty eight patients (188 cases), who had a primary diagnosis of osteoarthritis, and an intact functioning posterior cruciate ligament, were enrolled in this study. The patients were randomized regardless of the level of posterior cruciate ligament preservation. One hundred and eighty eight cases had a minimum 6-year follow-up, which included 96 and 92 cases in the PCR and PS groups, respectively. RESULTS: The Knee Society Score, the Hospital for Special Surgery (HSS) knee rating scores, average flexion contracture and radiologic alignment improved significantly, but there were no significant difference between the two groups. On the other hand, the mean postoperative flexion angles in the PCR and PS knees increased from 114.7degrees to 121.2degrees and 119.3degrees to 131.3degrees, respectively (p<0.05). CONCLUSION: There were no significant differences between PCR and PS TKA in the follow-up knee scores. However, the level of postoperative improvement in further flexion was better in the PS group.

Total Knee Arthroplasty with NexGen(R) System: 3-8 Year Follow-up Results / 대한정형외과학회잡지

PURPOSE: To evaluate the 3 to 8 year follow-up clinical and radiological results after NexGen(R) total knee arthroplasty (TKA). MATERIALS AND METHODS: Ninety-six knees in 75 patients, who could be followed up more than 3 years after NexGen(R) TKA [cruciate retaining (CR) type:34, posterior cruciate substituting (PS) type:62] from March 1997 to May 2002, were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), Knee Society Score (KSS), knee functional score, tibiofemoral angle and postoperative complications. RESULTS: The ROM increased from preoperative mean flexion contracture of 9.3 degrees and further flexion of 116.4 degrees to a postoperative mean flexion contracture of 2.1 degrees and further flexion of 126.3 degrees (ROM: 124.2 degrees). The ROM of CR type improved from 112.7 degrees to 123.1 degrees, and the PS type improved from 105.3 degrees to 124.9 degrees (p>0.05). The KSS and knee function score improved from 54 and 41 before surgery to 94 and 87 after surgery, respectively (p>0.05). The tibiofemoral angle changed from preoperative varus 5.7 degrees to postoperative valgus 5.2 degrees. The complications were two cases of infection and two cases of early loosening. CONCLUSION: The 3 to 8 year follow-up results after NexGen(R) TKA were satisfactory in both the CR and PS types. However, a longer term follow-up evaluation will be necessary.

Results of Posterior Cruciate Retaining and Cruciate Substituting Total Knee Arthroplasty (3 to 8 years follow up)

PURPOSE : To compare the clinical, roentgenographic results and patient self assessment between posterior cruciate retaining TKA and posterior cruciate substituting TKA. MATERIALS AND METHODS : From January 1993 to May 1999, 68 patients (106 knees) were performed total knee arthroplasty using the PFC system. Seventy five PCL retaining and thirty one PCL substituting components were used. Retrospective analysis were done in two groups by the clinical and radiological evaluation system using American Knee Society Scale and patient self assessment using WOMAC score. RESULTS : There were no statistically significant differences in knee score and functional score, improvement of range of motion, and self assesment of the PCL retaining and substituting group. We also observed improvement of pain, knee scores, and functional scores according to flexion contracture in both groups but there were no significant differences statistically. Tibiofemoral angles were corrected in both groups. There was no case of complete radiolucency, osteolysis, and component loosening. CONCLUSION : Surgeons will achieve good result of operation, if they choose proper type of TKA systems according to state of posterior cruciate ligament, degree of deformity, and technique of surgery.

The Results of PFC Total Knee Arthroplasty: comparative study of cruciate retaining versus substitution and cement versus cementless fixation / 대한정형외과학회잡지

PURPOSE: To analyze clinical, radiological results and survival rates of Press Fit Condylar total knee arthroplasty and compare the results of cruciate-retaining versus cruciate-substitution, and cement versus cementless fixation. MATERIALS AND METHODS: We analyzed 364 patients, 520 knees, which had undergone PFC total knee arthroplasty during the period January 1988 to January 1999. Average follow-up period was 7.1 years (3-14 years). Cases were divided into 2 categories: cruciate-retaining (CR) versus substitution (CS) and cement versus cementless fixation. The clinical results were evaluated using the Hospital for Special Surgery knee scoring system and radiological results were obtained by measuring tibiofemoral angle using Bauer's method. Survivorship analysis was performed using Kaplan-Meier method with revision for any reason as the end point. RESULTS: Clinical, radiological results and the survival rate in the cruciate substitution group were slightly better than those of the cruciate retaining group but no statistical difference was found. Survival rate in the cemented group was significantly higher than that in the cementless group. Clinical and radiological results of the cemented group were better but there was no statistical significance between the two groups. CONCLUSION: No differences were found in the postoperative results of the CR and CS groups. Survival rate in the cemented group was superior to that of the cementless group, which was used even in good bone stock and less deformed cases. This results may be related to a design problem of the cementless prosthesis.

Results of Posterior Cruciate Retaining Total Knee Arthroplasty (3 to 8 years follow up) / 대한정형외과학회잡지

PURPOSE: To evaluate clinical results of posterior cruciate retaining TKA according to the preoperative range of motion (ROM), degree of deformity and obesity. MATERIALS AND METHODS: 81 cases were followed up more than 3 years. All cases were evaluated according to degree of preoperative ROM and varus deformity, presence of flexion contracture and BMI scale for obesity. Clinical and radiological evaluation systems were used with American knee society scale. RESULTS: Postoperative ROM according to the degree of preoperative ROM showed that the postoperative ROM in the good preoperative ROM group was better compared to the worse preoperative ROM groups and the results of knee scores showed the similar condition. Flex-ion contracture group revealed the better clinical results (p>0.05) compared to the group without contracture. The improvement of knee and functional scores was statistically significant in the more deformed varus groups and in the normal BMI group compared to the more obese groups. CONCLUSION: Good clinical results and satisfactory postoperative ROM are obtained by the good preoperative ROM, appropriate technique of maintaining adequate soft tissue balance in the deformed knee and preoperative weight control.