Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty
- 1k Downloads
Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants. From a patient-centred view, bicruciate-retaining models provide a more natural feeling knee. However, there is no evidence of functional advantage for these implants. The aim of this study was to evaluate balance ability as a measure of proprioception in patients with a bicruciate-retaining total knee arthroplasty.
A prospective, controlled trial was conducted to compare balance ability in 60 patients after arthroplasty of the knee for osteoarthritis. We compared patients with a bicruciate-retaining knee arthroplasty (BCR group) to a control group of patients with a medial unicompartmental knee arthroplasty (UKA group) and another control group of patients with a posterior stabilized total knee arthroplasty (PS group). The patient population comprised 30 women (50.0 %) and 30 men in three cohorts of 20 each. The mean age was 62.1 ± 8.0 years (range 43–78). Patients were evaluated preoperatively and 9 months post-operatively. The evaluation included clinical, radiological, and balance testing—a single-leg stance with eyes closed compared to eyes open. The difference in area of sway between eyes closed and eyes open represents static balance ability after knee arthroplasty.
Perioperative data showed that there was no intra-operative fracture of the intercondylar eminence. There was a decreased post-operative knee extension 9 months post-operative in the BCR group, which was not clinically relevant in any case. We recorded a lower difference in the area of sway between eyes closed and eyes open (ΔA (ec–eo)) for the BCR group (p = 0.01) and the UKA group (p = 0.04) compared to the PS group.
This study found superior static balance ability after preservation of both cruciate ligaments in arthroplasty of the knee, indicating superior proprioceptive function. Hence, BCR implants could provide improved functional properties. Superior proprioceptive function of bicruciate-retaining implants can be an important factor in implant selection. Further prospective, randomized studies to investigate kinematics and long-term survivorship of bicruciate-retaining implants are needed.
Level of evidence
KeywordsUnicompartmental knee arthroplasty (UKA) Bicruciate-retaining total knee arthroplasty (BCR-TKA) Outcome Proprioception
Compliance with ethical standards
Conflict of interests
The authors declare that they have no conflict of interest.
- 7.Fuchs S, Frisse D, Laass H, Thorwesten L, Tibesku CO (2004) Muscle strength in patients with unicompartmental arthroplasty. Am J Phys Med Rehabil 83(8):650–654; quiz 655–657, 662Google Scholar
- 13.Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
- 17.Lombardi AV (2015) The bi-cruciate retaining TKA: “a thing of beauty is ajoy forever”—affirms. Bone Joint J Suppl 97-B(SUPP 1):69Google Scholar
- 33.Verra WC, van den Boom LG, Jacobs W, Clement DJ, Wymenga AA, Nelissen RG (2013) Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev 10:CD004803Google Scholar