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Equivalent outcomes of ultra-congruent and standard cruciate-retaining inserts in total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

No systematic review has compared the clinical outcome of anterior stabilized ultra-congruent and standard cruciate-retaining inserts in fixed-bearing primary total knee arthroplasty. This study aimed to compare the outcomes and establish the superiority or equivalence of these inserts.

Methods

Pubmed, EMBASE, Medline, AMED, ERIC, and Proquest databases were searched electronically. PRISMA guidelines were followed in the conduct of the study. The clinical outcomes compared in the meta-analysis were overall knee score, WOMAC, score for knee function, score for knee pain, SF-12 PCS, knee flexion, manipulation under anaesthesia for postoperative knee stiffness, revision total knee arthroplasty or change of polyethylene insert for post-operative instability (relative risk [RR]) and survivorship. Study quality was evaluated using the Newcastle Ottawa Scale and the Modified Jadad scale.

Results

Fourteen studies comprising 9989 knees (three RCTs and 11 comparative case-cohort studies) were included for qualitative and quantitative analysis. The pooled analysis of the ultracongruent insert and the standard cruciate retaining insert was based on a cohort of 2860 and 7129 TKA, respectively. Knee pain was significantly better in patients that had standard inserts (p = 0.02; 95% CI − 1.06 to − 0.10), and the physical component of health-related quality of life was also significantly better in patients that had standard inserts (p = 0.02; 95% CI − 6.43 to − 0.64). There was a 72% lesser chance of revision TKA or change of insert for postoperative instability in knees that had been implanted with ultracongruent inserts (RR = 0.28; p = 0.0002; 95% CI 0.15–0.55). There was no difference in the otheroutcome measures. There was no significant difference between the two inserts, considering the minimal clinically important difference or absolute ratio.

Conclusion

Differences observed between the two types of inserts were not clinically significant. Therefore, based on current evidence, arthroplasty surgeons can use either of these inserts with cruciate-retaining knee prosthesis.

Level of evidence

Therapeutic study, Level II.

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Acknowledgements

The authors would like to thank Mr Ian Braithwaite (Consultant Spine Surgeon, Chester, United Kingdom) for the help in revising the manuscript.

Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Limda, Waghodia, Vadodara, Gujarat, 391760, India

    Karthik Vishwanathan

  2. Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, 531127, India

    Srinivas B. S. Kambhampati

  3. Indraprastha Apollo Hospitals, New Delhi, India

    Raju Vaishya

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  1. Karthik Vishwanathan
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  3. Raju Vaishya
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Contributions

All authors [KV, SK and RV] contributed to the study conception and design. Material preparation, data collection and analysis were performed by KV and SK. The first draft of the manuscript was written by KV and all authors commented on previous versions of the manuscript. All authors [KV, SK and RV] read and approved the final manuscript.

Corresponding author

Correspondence to Karthik Vishwanathan.

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Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article

Ethics approval

The study protocol was reviewed by the Institutional Ethics Committee of Parul University, Vadodara (PUIECHR / PIMSR/ 00/ 081734/ 3913). It was granted exempt review since the study involved pooling and analysis of data that already exists in the public domain. There is no patient identifying information in the present manuscript.

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Vishwanathan, K., Kambhampati, S.B.S. & Vaishya, R. Equivalent outcomes of ultra-congruent and standard cruciate-retaining inserts in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 3076–3091 (2022). https://doi.org/10.1007/s00167-021-06833-z

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  • DOI: https://doi.org/10.1007/s00167-021-06833-z

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