Skip to main content
Log in

Reduced joint-awareness in bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

There is rising impact of patient-reported outcome (PRO) measurement in joint arthroplasty over the past years. Bicruciate-retaining implants have shown more physiologic knee kinematics and provide superior proprioceptive capacities. The aim of this study was to evaluate if the functional properties of this new implant design lead to improved PRO results after total knee arthroplasty (TKA).

Methods

This prospective, controlled trial compares PRO of bicruciate-retaining total knee arthroplasty (BCR-TKA) to unicondylar knee arthroplasty (UKA) and standard posterior-stabilized total knee arthroplasty (PS-TKA). We evaluated 102 patients (34 patients in each group) 18 months postoperatively after knee arthroplasty. Primary outcome measure was the Forgotten Joint Score (FJS).

Results

The BCR-group showed the same level of joint awareness as the UKA-group (p = 0.999). The second control group of PS-TKA patients had a lower mean score value in the FJS compared to the BCR-group (p = 0.035) and UKA-group (p = 0.031). There was no correlation of age, gender, body mass index (BMI) and the FJS. No relevant floor- or ceiling effects occurred.

Conclusions

This study found reduced joint awareness for BCR-TKA compared to a standard total knee arthroplasty. The score values of the BCR-group were equal to the UKA-group. Further prospective, randomized studies to investigate long-term survivorship of bicruciate-retaining implants are needed.

Level of evidence

Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Amiri S, Wilson DR (2012) A computational modeling approach for investigating soft tissue balancing in bicruciate retaining knee arthroplasty. Comput Math Methods Med 2012:652865. https://doi.org/10.1155/2012/652865

    Article  PubMed  PubMed Central  Google Scholar 

  2. Baker P, Petheram T, Jameson S, Reed M, Gregg P, Deehan D (2012) The association between body mass index and the outcomes of total knee arthroplasty. J Bone Jt Surg Am Vol 94(16):1501–1508. https://doi.org/10.2106/JBJS.K.01180

    Article  Google Scholar 

  3. Baumann F, Bahadin O, Krutsch W, Zellner J, Nerlich M, Angele P, Tibesku CO (2016) Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-016-4121-2

    PubMed  Google Scholar 

  4. Baumann F, Ernstberger T, Loibl M, Zeman F, Nerlich M, Tibesku C (2016) Validation of the German Forgotten Joint Score (G-FJS) according to the COSMIN checklist: does a reduction in joint awareness indicate clinical improvement after arthroplasty of the knee? Arch Orthop Trauma Surg 136(2):257–264. https://doi.org/10.1007/s00402-015-2372-x

    Article  PubMed  Google Scholar 

  5. Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 27(3):430–436 e431. https://doi.org/10.1016/j.arth.2011.06.035

    Article  PubMed  Google Scholar 

  6. Berend KR, Berend ME, Dalury DF, Argenson JN, Dodd CA, Scott RD (2015) Consensus statement on indications and contraindications for medial unicompartmental knee arthroplasty. J Surg Orthop Adv 24(4):252–256

    Article  PubMed  Google Scholar 

  7. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63. https://doi.org/10.1007/s11999-009-1119-9

    Article  PubMed  Google Scholar 

  8. Calliess T, Ettinger M, Schado S, Becher C, Hurschler C, Ostermeier S (2016) Patella tracking and patella contact pressure in modular patellofemoral arthroplasty: a biomechanical in vitro analysis. Arch Orthop Trauma Surg 136(6):849–855. https://doi.org/10.1007/s00402-016-2451-7

    Article  PubMed  Google Scholar 

  9. Cao S, Liu N, Han W, Zi Y, Peng F, Li L, Fu Q, Chen Y, Zheng W, Qian Q (2017) Simplified Chinese version of the Forgotten Joint Score (FJS) for patients who underwent joint arthroplasty: cross-cultural adaptation and validation. J Orthop Surg Res 12(1):6. https://doi.org/10.1186/s13018-016-0508-5

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Harwin SF, Mont MA (2014) Bicruciate-retaining total knee arthroplasty: a review. J Knee Surg 27(3):199–205. https://doi.org/10.1055/s-0034-1374812

    Article  PubMed  Google Scholar 

  11. Cloutier JM (1983) Results of total knee arthroplasty with a non-constrained prosthesis. J Bone Jt Surg Am Vol 65(7):906–919

    Article  CAS  Google Scholar 

  12. Cloutier JM, Sabouret P, Deghrar A (1999) Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study. J Bone Jt Surg Am Vol 81(5):697–702

    Article  CAS  Google Scholar 

  13. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res 63(Suppl 11):S208-228. https://doi.org/10.1002/acr.20632

    Google Scholar 

  14. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Jt Surg Br Vol 80(1):63–69

    Article  CAS  Google Scholar 

  15. Ettinger M, Zoch JM, Becher C, Hurschler C, Stukenborg-Colsman C, Claassen L, Ostermeier S, Calliess T (2015) In vitro kinematics of fixed versus mobile bearing in unicondylar knee arthroplasty. Arch Orthop Trauma Surg 135(6):871–877. https://doi.org/10.1007/s00402-015-2214-x

    Article  PubMed  Google Scholar 

  16. Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, Goldman L, Mangione CM (2004) Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum 51(1):100–109. https://doi.org/10.1002/art.20090

    Article  PubMed  Google Scholar 

  17. Fuchs S, Frisse D, Laass H, Thorwesten L, Tibesku CO (2004) Muscle strength in patients with unicompartmental arthroplasty. Am J Phys Med Rehabil Assoc Acad Phys 83(8):650–654 quiz 655–657, 662

    Article  CAS  Google Scholar 

  18. Fuchs S, Frisse D, Tibesku CO, Laass H, Rosenbaum D (2002) Proprioceptive function, clinical results, and quality of life after unicondylar sledge prostheses. Am J Phys Med Rehabil Assoc Acad Physiatr 81(7):478–482

    Article  CAS  Google Scholar 

  19. Fuchs S, Tibesku CO, Frisse D, Genkinger M, Laass H, Rosenbaum D (2005) Clinical and functional comparison of uni- and bicondylar sledge prostheses. Knee Surg Sports Traumatol Arthrosc 13(3):197–202. https://doi.org/10.1007/s00167-004-0580-y

    Article  CAS  PubMed  Google Scholar 

  20. Fuchs S, Tibesku CO, Genkinger M, Laass H, Rosenbaum D (2003) Proprioception with bicondylar sledge prostheses retaining cruciate ligaments. Clin Orthop Relat Res 406:148–154. https://doi.org/10.1097/01.blo.0000038053.29678.a5

    Article  Google Scholar 

  21. Goutallier D, Manicom O, Van Driessche S (2008) Total knee arthroplasty with bicruciate preservation: comparison versus the same posterostabilized design at eight years follow-up. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 94(6):585–595. https://doi.org/10.1016/j.rco.2008.04.012

    Article  CAS  PubMed  Google Scholar 

  22. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  23. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Komistek RD, Allain J, Anderson DT, Dennis DA, Goutallier D (2002) In vivo kinematics for subjects with and without an anterior cruciate ligament. Clin Orthop Relat Res 404:315–325

    Article  Google Scholar 

  25. Li D, Troelsen A, Ingelsrud L, Husted H, Gromov K (2017) Females, younger patients and patients with high BMI have the highest pre-operative knee awareness measured using the Forgotten Joint Score. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4446-5

    Google Scholar 

  26. Lombardi AV (2015) THE BI-CRUCIATE RETAINING TKA: “A THING OF BEAUTY IS A JOY FOREVER”—AFFIRMS. Bone Jt J Orthop Proc Suppl 97-B(SUPP 1):69

    Google Scholar 

  27. Lygre SH, Espehaug B, Havelin LI, Furnes O, Vollset SE (2010) Pain and function in patients after primary unicompartmental and total knee arthroplasty. J Bone Jt Surg Am Vol 92(18):2890–2897. https://doi.org/10.2106/JBJS.I.00917

    Article  Google Scholar 

  28. Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW (2012) Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res 470(1):84–90. https://doi.org/10.1007/s11999-011-2144-z

    Article  PubMed  Google Scholar 

  29. Matthews DJ, Hossain FS, Patel S, Haddad FS (2013) A Cohort Study Predicts Better Functional Outcomes and Equivalent Patient Satisfaction Following UKR Compared with TKR. HSS J Musculoskelet J Hosp Special Surg 9(1):21–24. https://doi.org/10.1007/s11420-012-9326-4

    Google Scholar 

  30. Moro-oka TA, Muenchinger M, Canciani JP, Banks SA (2007) Comparing in vivo kinematics of anterior cruciate-retaining and posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15(1):93–99. doi:https://doi.org/10.1007/s00167-006-0134-6

    Article  PubMed  Google Scholar 

  31. Nielsen KA, Thomsen MG, Latifi R, Kallemose T, Husted H, Troelsen A (2016) Does post-operative knee awareness differ between knees in bilateral simultaneous total knee arthroplasty? Predictors of high or low knee awareness. Knee Surg Sports Traumatol Arthrosc 24(10):3352–3358. https://doi.org/10.1007/s00167-016-4013-5

    Article  PubMed  Google Scholar 

  32. Parvizi J, Nunley RM, Berend KR, Lombardi AV Jr, Ruh EL, Clohisy JC, Hamilton WG, Della Valle CJ, Barrack RL (2014) High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 472(1):133–137. https://doi.org/10.1007/s11999-013-3229-7

    Article  PubMed  Google Scholar 

  33. Peersman G, Slane J, Dirckx M, Vandevyver A, Dworschak P, Heyse TJ, Scheys L (2017) The influence of polyethylene bearing thickness on the tibiofemoral kinematics of a bicruciate retaining total knee arthroplasty. Knee 24(4):751–760. https://doi.org/10.1016/j.knee.2017.03.010

    Article  PubMed  Google Scholar 

  34. Pritchett JW (2011) Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplasty 26(2):224–228. https://doi.org/10.1016/j.arth.2010.02.012

    Article  PubMed  Google Scholar 

  35. Pritchett JW (2015) Bicruciate-retaining total knee replacement provides satisfactory function and implant survivorship at 23 years. Clin Orthop Relat Res 473(7):2327–2333. https://doi.org/10.1007/s11999-015-4219-8

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pynsent PB, Adams DJ, Disney SP (2005) The Oxford hip and knee outcome questionnaires for arthroplasty. J Bone Jt Surg Br Vol 87(2):241–248

    Article  CAS  Google Scholar 

  37. Rorabeck CH, Taylor JW (1999) Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin N Am 30(2):209–214

    Article  CAS  Google Scholar 

  38. Sabouret P, Lavoie F, Cloutier JM (2013) Total knee replacement with retention of both cruciate ligaments: a 22-year follow-up study. Bone Jt J 95-B(7):917–922. https://doi.org/10.1302/0301-620X.95B7.30904

    Article  CAS  Google Scholar 

  39. Schultz RA, Miller DC, Kerr CS, Micheli L (1984) Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Jt Surg Am Vol 66(7):1072–1076

    Article  CAS  Google Scholar 

  40. Shadid MB, Vinken NS, Marting LN, Wolterbeek N (2016) The Dutch version of the Forgotten Joint Score: test–retesting reliability and validation. Acta Orthop Belg 82(1):112–118

    PubMed  Google Scholar 

  41. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  42. Thienpont E, Opsomer G, Koninckx A, Houssiau F (2014) Joint awareness in different types of knee arthroplasty evaluated with the Forgotten Joint score. J Arthroplasty 29(1):48–51. https://doi.org/10.1016/j.arth.2013.04.024

    Article  PubMed  Google Scholar 

  43. Thomsen MG, Latifi R, Kallemose T, Husted H, Troelsen A (2016) Does knee awareness differ between different knee arthroplasty prostheses? A matched, case-control, cross-sectional study. BMC Musculoskelet Disord 17:141. https://doi.org/10.1186/s12891-016-1001-3

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ward TR, Burns AW, Gillespie MJ, Scarvell JM, Smith PN (2011) Bicruciate-stabilised total knee replacements produce more normal sagittal plane kinematics than posterior-stabilised designs. J Bone Jt Surg Br Vol 93(7):907–913. https://doi.org/10.1302/0301-620X.93B7.26208

    Article  CAS  Google Scholar 

  45. Zuiderbaan HA, van der List JP, Khamaisy S, Nawabi DH, Thein R, Ishmael C, Paul S, Pearle AD (2017) Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc 3:681–686. https://doi.org/10.1007/s00167-015-3868-1

Download references

Acknowledgements

This study was supported by the European Knee Society.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Florian Baumann.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baumann, F., Krutsch, W., Worlicek, M. et al. Reduced joint-awareness in bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing total knee arthroplasty. Arch Orthop Trauma Surg 138, 273–279 (2018). https://doi.org/10.1007/s00402-017-2839-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-017-2839-z

Keywords

Navigation