Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatmen
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KNEE ARTHROPLASTY
Higher revision rate for posterior cruciate‑retaining than posterior‑stabilized total knee arthroplasty for the treatment of valgus osteoarthritis Peter Savov1 · Evelyn Mielke1 · Henning Windhagen1 · Tilman Calliess2 · Alena Richter1 · Max Ettinger1 Received: 10 October 2019 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Determining the point at which a valgus deformity requires a more invasive therapy—in this case PS TKA—is surgically challenging. Retaining the posterior cruciate ligament has both advantages and disadvantages. The aim was to evaluate the failure rate and clinical outcomes. Methods 248 patients with valgus gonarthrosis underwent surgical treatment: 167 CR TKA cases and 81 PS TKA cases. The KOOS and the OKS were recorded, and 201 patients (133 CR, 68 PS) were recruited into the retrospective study. The influence of BMI and degree of preoperative valgus deformity on the clinical outcome was determined. The revision rate was documented and analysed. Results Of 201 patients, 10 required revision surgery owing to instability (10/133 CR, 0/68 PS). Based on the KOOS and the OKS, no significant difference between CR TKA and PS TKA was found. BMI and degree of valgus deformity had no effect on the clinical outcome. Conclusions No difference in the clinical outcome between the CR and PS TKA patients was found. In the CR group, significantly more patients showed ‘excellent’ OKS than in the PS group. However, 8.0% of the patients in the CR group and none in the PS group underwent surgery due to instability. A higher rate of dissatisfied patients in the CR group is likely. In our clinic, we no longer perform CR TKA for valgus cases. Keywords Valgus · Cruciate retaining · Posterior stabilized · Sagittal instability · TKA Abbreviations ADL Activities of daily living CR Cruciate-retaining ITB Iliotibial band KOOS Knee injury and Osteoarthritis Outcome Score LCL Lateral collateral ligament MCL Medial collateral ligament Peter Savov and Evelyn Mielke contributed equal to this manuscript. * Peter Savov peter@savov‑medizin.de * Max Ettinger [email protected] 1
Department of Orthopedic Surgery, Hannover Medical School, Anna‑von‑Borries‑Strasse 1‑7, 30625 Hanover, Germany
Articon Christenorto AG, Schänzlistrasse 39, 3013 Bern, Switzerland
2
OKS Oxford Knee Score PCL Posterior cruciate ligament PLC Posterolateral capsule POP Popliteal tendon PS Posterior-stabilized QOL Quality of life RCT Randomized controlled trial TKA Total knee arthroplasty
Introduction The debate surrounding cruciate-retaining (CR) versus posterior-stabilized (PS) designs in total knee arthroplasty (TKA) is ongoing. In cruciate-retaining TKA, there is no resection of the posterior cruciate ligament (PCL). After the surgery, the PCL furthermore stabilizes the knee joint at the anterior–posterior level. This stabilization is replaced by the design of the PS prosthesis. In this connection, the stability is created by a pin on the inlay. With
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