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Superior patient satisfaction in medial pivot as compared to posterior stabilized total knee arthroplasty: a prospective randomized study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Medial pivot (MP) total knee arthroplasty (TKA) aims to restore native knee kinematics due to highly conforming medial tibio-femoral articulation with survival comparable to contemporary knee designs. Posterior stabilized (PS) TKAs use cam-post mechanism to restore native femoral rollback. However, there is conflicting evidence regarding the reported patient satisfaction with MP TKA designs when compared to PS TKAs. The primary aim of this study is to compare the patient satisfaction between MP and PS TKA and the secondary aim is to establish potential reasons behind any differences in the outcomes noted between these two design philosophies.

Methods

In this IRB-approved single surgeon, single centre prospective RCT, 53 patients (mean age 62 years, 42 women) with comparable bilateral end-stage knee arthritis undergoing simultaneous bilateral TKA were randomized to receive MP TKA in one knee and PS TKA in the contralateral knee. At 4 years post-surgery, all patients were assessed using Knee Society Score (KSS)-Satisfaction and -Expectation scores, and Oxford Knee Score (OKS). In addition, all the patients underwent standardized radiological and in vivo kinematic assessment.

Results

Patients were more satisfied with the MP TKA as compared to PS TKA: mean KSS-Satisfaction [34.5 ± 3.05 in MP and 31.7 ± 3.16 in PS TKAs (p < 0.0001)] and mean KSS-Expectation scores [12.5 ± 1.39 in MP TKAs and 11.2 ± 1.41 in PS TKAs (p < 0.0001)]. No significant difference was noted in any other clinical outcomes. The in vivo kinematics of MP TKAs was significantly better than those of PS TKAs.

Conclusion

MP TKAs provide superior patient satisfaction and patient expectations as compared to PS TKA. This may be related to better replication of natural knee kinematics with MP TKA.

Level of evidence

I.

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Author information

Author notes

  1. Both HP and DB are senior and equal authors.

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India

    Sahil Batra, Rajesh Malhotra & Vijay Kumar

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India

    Deep Narayan Srivastava

  3. Division of Orthopaedics, Granovsky Gluskin Chair in Complex Hip & Knee Reconstruction, Sinai Health System, University of Toronto, Toronto, Canada

    David Backstein

  4. Chapel Allerton Hospital, University of Leeds, Leeds, UK

    Hemant Pandit

  5. Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Room No 139, Teaching Block, Ansari Nagar, New Delhi, 110029, India

    Rajesh Malhotra

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Contributions

SB drafted the manuscript and performed all the measurements. RM conceived the study and performed all the surgeries. VK participated in the design of the study. DN carried out measurement of radiological and kinematic data independently. HP and DB shaped the final version of the manuscript. All the authors read and approved the manuscript.

Corresponding author

Correspondence to Rajesh Malhotra.

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Conflict of interest

SB, RM, VK and DN have no conflict of interest. DB reports personal fees from Microport Orthopedics and Chairs Editorial Board Office at Journal of Arthroplasty, Clinical Orthopaedics and Related Research and held shares in Intelijoint Surgical outside the submitted work. HP reports personal fees from Zimmer Biomet, Medacta, Depuy Synthes and Meril Life, and grants from Zimmer Biomet, Depuy Synthes and GSK outside the submitted work. HP is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care.

Funding

This study did not receive any funding of any nature.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Batra, S., Malhotra, R., Kumar, V. et al. Superior patient satisfaction in medial pivot as compared to posterior stabilized total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 29, 3633–3640 (2021). https://doi.org/10.1007/s00167-020-06343-4

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  • DOI: https://doi.org/10.1007/s00167-020-06343-4

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