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Cruciate-substituting and posterior-stabilised total knee arthroplasties had similar gait patterns in the short term

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Surgeons want to achieve native kinematics in primary total knee arthroplasty (TKA). Cruciate-substituting (CS) implants could restore the knee kinematics more efficiently than posterior-stabilised (PS) TKA. This study aimed to compare gait patterns in patients with CS or PS TKA at 6 months. The hypothesis was that CS implants would demonstrate comparable gait parameters to PS implants at 6 months.

Methods

In this prospective case–control study, 38 primary TKA without coronal laxity were divided into 2 groups: 19 cruciate-substituting (CS) and 19 posterior-stabilised (PS) implants. The type of prosthesis was determined according to the surgical period. Exclusion criteria were TKA revision, associated procedures and inability to walk on a treadmill. Gait analysis was conducted on a treadmill 6 months postoperatively for each patient with a knee assessment device (KneeKG®). Gait characteristics included analysis in three spatial dimensions (flexion–extension, abduction–adduction, internal–external rotation, anterior–posterior translation). Clinical outcomes (Knee Society Score and Forgotten Joint Score) were compared between both groups at 6 months postoperatively.

Results

At 6 months, the gait analysis did not demonstrate any significant difference between CS and PS implants. The range and the maximum anteroposterior translation were similar in both groups (9.2 ± 6.5 mm in CS group vs. 8.1 ± 3 mm in PS group (n.s.); and − 5.2 ± 5 mm in CS group vs. − 6.3 ± 5.9 mm in PS group (n.s.), respectively). The internal/external rotation, the flexion, and the varus angle were similar between CS and PS implants. The KSS Knee score was higher at 6 months in the CS group than in the PS group (92.1 ± 5.6 vs. 84.8 ± 8.9 (p < 0.01)).

Conclusion

Cruciate-substituting and posterior-stabilised TKA had similar gait patterns at 6 months postoperatively, despite a non-equivalent posterior stabilisation system. CS prostheses were an interesting option for primary TKA for knee kinematics restoration without requiring a femoral box.

Level of evidence

Prospective, case–control study; Level II.

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Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France

    Clément Favroul, Cécile Batailler, Constant Foissey, Moussa Kafelov, Elvire Servien & Sébastien Lustig

  2. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France

    Cécile Batailler, Alexandre Naaim, Laurence Cheze & Sébastien Lustig

  3. LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

Authors
  1. Clément Favroul
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  2. Cécile Batailler
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  3. Alexandre Naaim
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  4. Constant Foissey
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  5. Moussa Kafelov
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  6. Laurence Cheze
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  7. Elvire Servien
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  8. Sébastien Lustig
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Contributions

CF: study design, data collection, statistical analysis, literature review and manuscript writing. CB: study design, literature review, manuscript editing and supervision. AN: statistical analysis and manuscript editing. CoFO: data collection, literature review and manuscript editing. MK: data collection, literature review and manuscript editing. LC: study design and manuscript editing. ES: study design, literature review and manuscript editing. SL: study design, supervision, literature review and manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cécile Batailler.

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Conflict of interest

CF, CB, AN, CoFo, MK and LC declare that they have no conflict of interest. ES: consultant for Corin. SL: consultant for Stryker, Smith Nephew, Heraeus, Depuy Synthes; Institutional research support from Groupe Lepine, Amplitude; Editorial Board for Journal of Bone and Joint Surgery (Am).

Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Helsinki declaration and its later amendments, or comparable ethical standards. Data collection and analysis were carried out in accordance with MR004 Reference Methodology from the Commission Nationale de l'Informatique et des Libertés (Ref. 2229975V0) obtained 6 May 2023. The study was registered and filed on the Health Data Hub website.

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Favroul, C., Batailler, C., Naaim, A. et al. Cruciate-substituting and posterior-stabilised total knee arthroplasties had similar gait patterns in the short term. Knee Surg Sports Traumatol Arthrosc 31, 5398–5406 (2023). https://doi.org/10.1007/s00167-023-07594-7

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