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Comparison of Functional Outcomes, Femoral Rollback and Sagittal Stability of Anterior-Stabilized Versus Posterior-Stabilized Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Abstract

Purpose

Total knee arthroplasty (TKA) has improved leaps and bounds in terms of design to improve clinical outcomes and achieve better rehabilitation of the patients. Ultra-congruent inserts (UC) were designed to replace the need for posterior stabilized (PS) implants. The purpose of this review was to evaluate clinical outcomes, femoral rollback, functional scores, range of motion, sagittal laxity, complication rates, and isokinetic performance between UC and PS TKA among RCTs

Methods

Electronic databases such as PubMed, Scopus, opengrey, and Cochrane were searched from date of inception up to mid-April 2021, and meta-analysis was performed following PRISMA guidelines. This study analyzed outcomes, femoral rollback, tibial sagittal laxity and isokinetic performance.

Results

Ten RCTs identified 852 knees, of which 420 underwent UC TKAs and 432 underwent PS TKA. Compared to UC TKA, a significantly better sagittal stability (p = 0.17) and femoral rollback (p < 0.00001) in PS TKAs was noted, although no statistically significant difference was found in the assessment of the range of motion (p = 0.19) and functional scores. Both the groups had similar isokinetic performance with extensor torque (p = 0.97) and flexor torque (p = 0.37).

Conclusions

We conclude with the current meta-analysis that there are no added benefits for UC over PS inserts and these inserts have a higher sagittal laxity and less femoral roll back in cruciate sacrificing UC knee. But since there are no long-term wear data, UC inserts with CS technique should be used cautiously and may be used only when the PCL cannot be balanced adequately. There is no evidence or only a few to support the superiority of the AS TKA in terms of clinical outcomes or isokinetic performance or femoral external rotation over PS TKA.

Level of Evidence

Level I, Systematic review and meta-analysis of RCTs.

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Data Availability

All included studies used in this systematic review and meta-analysis are available online. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Data regarding this study are not available in any electronic databases.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India

    Balgovind S.Raja, Aditya K. S. Gowda, Sajid Ansari, Arghya Kundu Choudhury & Roop Bhushan Kalia

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  1. Balgovind S.Raja
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Contributions

BSR: planning of study, literature search, writing the manuscript, and quality assessment of the included studies. AKSG: literature search, writing the manuscript, and quality assessment of the included studies. SA: data management, outcome assessment, and quality assessment of the included studies. AKC: data management, outcome assessment, and manuscript preparation. RBK: planning of study, quality assessment of the included studies, and writing and revising the manuscript.

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Correspondence to Roop Bhushan Kalia.

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S.Raja, B., Gowda, A.K.S., Ansari, S. et al. Comparison of Functional Outcomes, Femoral Rollback and Sagittal Stability of Anterior-Stabilized Versus Posterior-Stabilized Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials. JOIO 55, 1076–1086 (2021). https://doi.org/10.1007/s43465-021-00494-3

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