Anterior-stabilized TKA is inferior to posterior-stabilized TKA in terms of postoperative posterior stability and knee f
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KNEE
Anterior‑stabilized TKA is inferior to posterior‑stabilized TKA in terms of postoperative posterior stability and knee flexion in osteoarthritic knees: a prospective randomized controlled trial with bilateral TKA Hyuk‑Soo Han1 · Seung‑Baik Kang2 Received: 27 June 2019 / Accepted: 11 December 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To determine whether knee stability, range of motion (ROM) and clinical scores differ between anterior-stabilized (AS) and posterior-stabilized (PS) total knee arthroplasty (TKA). Methods This prospective randomized controlled trial included 34 patients with severe bilateral knee osteoarthritis who underwent bilateral TKA between June 2010 and July 2011 using AS and PS designs of a single-implant system. AS TKA with ultracongruent inserts was performed in one knee and PS TKA with a cam-post mechanism was performed in the other knee in each patient. Clinical and radiological data from a mean follow-up period of 5 years, including ROM, clinical scores, peak knee torque determined by isokinetic test, knee joint laxity determined by Telos stress views, tourniquet time and subjects’ preference were analyzed. Results The mean postoperative knee flexion angle did not differ between groups until 1 year. Beginning 2 years postoperatively, the knee flexion angle decreased slightly in the AS group and was smaller than that in the PS group (p = 0.004). The mean Knee Society knee score was higher in the PS group than in the AS group after 2 years. The quadriceps strength did not differ between groups. The mean posterior laxity after TKA was 6–8 mm greater in the AS group than in the PS group. No radiological loosening was observed in either group. More subjects preferred PS knees to AS knees. However, this difference was not significant. Conclusion AS primary TKA was inferior to PS TKA in terms of posterior knee stability, postoperative knee flexion and clinical scores after 2 years. Level of evidence Therapeutic study, Level 1. Keywords Anterior stabilization · Posterior stabilization · Sagittal stability · Range of motion · Total knee arthroplasty
Introduction Although retention or sacrifice of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) remains a matter of debate, substitution of the PCL is necessary in some situations such as severe coronal malalignment, fixed flexion contracture or PCL insufficiency [17]. To restore * Seung‑Baik Kang [email protected] 1
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, 20 Boramae 5th road, Dongjak‑Gu, Seoul 17061, South Korea
2
the physiological functions of the PCL and to limit posterior glide and restore femoral rollback during knee flexion, posterior stabilization (PS) using a cam-post mechanism is applied widely [7]. Drawbacks of this mechanism include post breakage, dislocation, patellar clunk syndrome and increased risk
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