Bi-cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes
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KNEE ARTHROPLASTY
Bi‑cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes Christoph Kolja Boese1,2 · Stephen Ebohon3 · Christian Ries4 · Diarmuid De Faoite5 Received: 7 May 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Total knee arthroplasty (TKA) has been shown to have good long-term outcomes and survivorship. Nonetheless, dissatisfied patients are frequently reported in the literature. Bi-cruciate retaining total knee prostheses (BCR TKA) were designed to address the demand for more kinematically functional implants that better reconstruct natural knee kinematics. In BCR TKA, the anterior cruciate ligament (ACL) is preserved. Improved patient-reported outcomes and satisfaction levels are expected. This review aimed to summarize indications for and clinical outcomes of BCR TKA. A systematic literature review on BCR TKA was performed. 24 articles were included for data analysis. Indications covered osteoarthritis, inflammatory arthritis and others. The degree of deformity was often but not always limited to minor axial deformity and contractures: maximum acceptable varus/valgus deformity reached 10°–30° and flexion contractures of 15°–65°. ACL intactness was macroscopically examined intraoperatively in nine studies and clinically tested in ten studies (e.g., Lachmann Test, drawer-test). Objective and patient-reported outcome scores were reported for follow-up periods of up to 22 years. Survival rates varied significantly. For first generation implants, 22-year survival reached 82% while a second generation design was associated with 13.5% revision rate at 18 months. Reasons for varying outcomes were not clear and may be attributed to the implant itself, surgical techniques and patient specific variables including changed expectations and functional demand. The literature has not shown clear indications and guidelines for the use of BCR implants. The promising results of first generation BCR TKA designs may be optimized through improved implant designs in the future. Further studies are advocated to provide the necessary evidence of second generation BCR TKA designs. Keywords Total knee arthroplasty · Anterior cruciate ligament · Osteoarthritis · Joint replacement · Systematic review Abbreviations ACL Anterior cruciate ligament BCR Bi-cruciate retaining total knee arthroplasty BMI Body mass index CR Cruciate retaining FU Follow-up KSS Knee Society Score OA Osteoarthritis * Christoph Kolja Boese Christoph.boese@uk‑koeln.de 1
Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
2
Smith + Nephew GmbH, Hamburg, Germany
3
Smith + Nephew, Hull, UK
4
Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
5
Smith + Nephew, Baar, Switzerland
PE Polyethylene PCL Posterior cruciate ligament PS Posterior stabilized ROM Range of motion TKA Total knee arthroplasty UKA Unicondylar knee arthroplasty
Introduction Joint
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