Skip to main content

Advertisement

SpringerLink
Log in

Posterior-stabilized inserts are preferable to cruciate-substituting ultracongruent inserts due to more favourable kinematics and stability

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

It is unknown whether the conforming superiority of ultracongruent (UC) inserts over posterior stabilized (PS) inserts, due to an increased anterior lip for prevention of anterior displacement of the condyles during knee flexion, leads to better knee scores or greater knee stability in arthroplasty patients. This meta-analysis compared clinical outcomes, intraoperative kinematics, sagittal stability, and range of motion (ROM) between groups with either UC or PS inserts in primary total knee arthroplasty (TKA).

Methods

Studies that recorded clinical outcomes, intraoperative kinematics, sagittal stability, and ROM in patients who underwent primary TKA with UC or PS inserts were included in the meta-analysis. Subgroup analyses based on differences in flexion angles were performed for intraoperative kinematics.

Results

Thirteen studies met the criteria for inclusion in the meta-analysis. The UC and PS insert groups reported similar pain scores (95% CI − 0.15 to 0.16; n.s.) and function scores (95% CI − 0.30 to 0.14; n.s.). In contrast, femoral rotation during flexion (95% CI − 0.06 to 6.35; p = 0.05), posterior femoral translation during flexion (95% CI − 2.74 to − 0.15; p = 0.03), tibial sagittal laxity at 90° (95% CI 2.91 to 7.72; p < 0.0001), and ROM (95% CI − 4.84 to − 1.53; p = 0.0002) differed significantly between the groups. Subgroup analyses revealed that the pooled data for femoral rotation were significantly different between groups: 60°, 4.09 (p < 0.00001); 90°, 7.94 (p < 0.00001); and 120°, 8.16 (p < 0.00001). Furthermore, pooled data for posterior femoral translation were significantly different between groups: 90°, − 3.70 (p < 0.00001); and 120°, − 3.96 (p < 0.00001).

Conclusions

There were no significant differences in clinical outcomes between the groups with UC and PS inserts. However, the UC insert group showed significantly greater external femoral rotation, less posterior femoral translation, greater tibial laxity in the sagittal plane, and less ROM than the PS insert group. Based on the results of the current meta-analysis, in substituting the PCL, PS inserts are preferable to UC inserts due to more favourable kinematics and stability, even though both inserts have equivalent clinical outcomes.

Level of evidence

Therapeutic study, Level II.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Argenson J-N, Boisgard S, Parratte S et al (2013) Survival analysis of total knee arthroplasty at a minimum 10 years’ follow-up: a multicenter French nationwide study including 846 cases. Orthop Traumatol Surg Res 99:385–390

    Article  Google Scholar 

  2. Bignozzi S, Zaffagnini S, Akkawi I et al (2014) Three different cruciate-sacrificing TKA designs: minor intraoperative kinematic differences and negligible clinical differences. Knee Surg Sports Traumatol Arthrosc 22:3113–3120

    Article  Google Scholar 

  3. Carothers JT, Kim RH, Dennis DA, Southworth C (2011) Mobile-bearing total knee arthroplasty: a meta-analysis. J Arthroplasty 26:537–542

    Article  Google Scholar 

  4. D’Lima DD, Trice M, Urquhart AG, Colwell CW Jr (2000) Comparison between the kinematics of fixed and rotating bearing knee prostheses. Clin Orthop Relat Res 380:151–157

    Article  Google Scholar 

  5. Daniilidis K, Skwara A, Vieth V et al (2012) Highly conforming polyethylene inlays reduce the in vivo variability of knee joint kinematics after total knee arthroplasty. Knee 19:260–265

    Article  Google Scholar 

  6. Dennis DA, Komistek RD, Mahfouz MR, Walker SA, Tucker A (2004) A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res 428:180–189

    Article  Google Scholar 

  7. Dennis DA, Komistek RD, Mahfouz MR, Outten JT, Sharma A (2005) Mobile-bearing total knee arthroplasty: do the polyethylene bearings rotate? Clin Orthop Relat Res 440:88–95

    Article  Google Scholar 

  8. Fedida BA, Krief E, Havet E, Massin P, Mertl P (2015) Cruciate-sacrificing total knee arthroplasty and insert design: a radiologic study of sagittal laxity. Orthop Traumatol Surg Res 101:941–945

    Article  Google Scholar 

  9. Fritzsche H, Beyer F, Postler A, Lützner J (2017) Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4427-8

    Article  PubMed  Google Scholar 

  10. Harato K, Bourne RB, Victor J, Snyder M, Hart J, Ries MD (2008) Midterm comparison of posterior cruciate-retaining versus-substituting total knee arthroplasty using the Genesis II prosthesis: a multicenter prospective randomized clinical trial. Knee 15:217–221

    Article  Google Scholar 

  11. Heyse TJ, Becher C, Kron N et al (2010) Patellofemoral pressure after TKA in vitro: highly conforming vs. posterior stabilized inlays. Arch Orthop Trauma Surg 130:191–196

    Article  Google Scholar 

  12. Hofmann AA, Tkach TK, Evanich CJ, Camargo MP (2000) Posterior stabilization in total knee arthroplasty with use of an ultracongruent polyethylene insert. J Arthroplasty 15:576–583

    Article  CAS  Google Scholar 

  13. Jain NP, Lee SY, Morey VM, Chong S, Kang YG, Kim TK (2017) Early clinical outcomes of a new posteriorly stabilized total knee arthroplasty prosthesis: comparisons with two established prostheses. Knee Surg Relat Res 29:180–188

    Article  Google Scholar 

  14. Kim MS, Koh IJ, Jang SW, Jeon NH, In Y (2016) Two-to four-year follow-up results of total knee arthroplasty using a new high-flexion prosthesis. Knee Surg Relat Res 28:39

    Article  Google Scholar 

  15. Kim TW, Lee SM, Seong SC, Lee S, Jang J, Lee MC (2016) Different intraoperative kinematics with comparable clinical outcomes of ultracongruent and posterior stabilized mobile-bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:3036–3043

    Article  Google Scholar 

  16. Lützner J, Firmbach F-P, Lützner C, Dexel J, Kirschner S (2015) Similar stability and range of motion between cruciate-retaining and cruciate-substituting ultracongruent insert total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:1638–1643

    Article  Google Scholar 

  17. Lützner J, Beyer F, Dexel J, Fritzsche H, Lützner C, Kirschner S (2016) No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 25:3515–3521

    Article  Google Scholar 

  18. Laskin RS, Maruyama Y, Villaneuva M, Bourne R (2000) Deep-dish congruent tibial component use in total knee arthroplasty: a randomized prospective study. Clin Orthop Relat Res 380:36–44

    Article  Google Scholar 

  19. Li N, Tan Y, Deng Y, Chen L (2014) Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 22:556–564

    Article  Google Scholar 

  20. Machhindra MV, Kang JY, Kang YG, Chowdhry M, Kim TK (2015) Functional outcomes of a new mobile-bearing ultra-congruent TKA system: comparison with the posterior stabilized system. J Arthroplasty 30:2137–2142

    Article  Google Scholar 

  21. Massin P, Boyer P, Sabourin M (2012) Less femorotibial rotation and AP translation in deep-dished total knee arthroplasty: an intraoperative kinematic study using navigation. Knee Surg Sports Traumatol Arthrosc 20:1714–1719

    Article  Google Scholar 

  22. Park SJ, Seon JK, Park JK, Song EK (2009) Effect of PCL on flexion-extension gaps and femoral component decision in TKA. Orthopedics 32:22–25

    Article  Google Scholar 

  23. Parsley BS, Conditt MA, Bertolusso R, Noble PC (2006) Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 21:127–131

    Article  Google Scholar 

  24. Paterson NR, Teeter MG, MacDonald SJ, McCalden RW, Naudie DD (2013) The 2012 Mark Coventry award: a retrieval analysis of high flexion versus posterior-stabilized tibial inserts. Clin Orthop Relat Res 471:56–63

    Article  Google Scholar 

  25. Peters CL, Mulkey P, Erickson J, Anderson MB, Pelt CE (2014) Comparison of total knee arthroplasty with highly congruent anterior-stabilized bearings versus a cruciate-retaining design. Clin Orthop Relat Res 472:175–180

    Article  Google Scholar 

  26. Scott RD, Thornhill TS (1994) Posterior cruciate supplementing total knee replacement using conforming inserts and cruciate recession: effect on range of motion and radiolucent lines. Clin Orthop Relat Res 309:146–149

    Google Scholar 

  27. Siebold R, Louisia S, Canty J, Bartlett RJ (2007) Posterior stability in fixed-bearing versus mobile-bearing total knee replacement: a radiological comparison of two implants. Arch Orthop Trauma Surg 127:97–104

    Article  CAS  Google Scholar 

  28. Singh AD (2016) Retrospective study of asymmetric vs symmetric tibial plates and ultracongruent vs. posterior stabilized inserts in Indian population: an Indian experience of Natural Knee II. J Clin Orthop Trauma 7:184–190

    Article  Google Scholar 

  29. Siston RA, Giori NJ, Goodman SB, Delp SL (2006) Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty. J Orthop Res 24:1607–1614

    Article  Google Scholar 

  30. Stukenborg-Colsman C, Ostermeier S, Hurschler C, Wirth CJ (2002) Tibiofemoral contact stress after total knee arthroplasty: comparison of fixed and mobile-bearing inlay designs. Acta Orthop Scand 73:638–646

    PubMed  Google Scholar 

  31. Sur YJ, Koh IJ, Park SW, Kim HJ, In Y (2015) Condylar-stabilizing tibial inserts do not restore anteroposterior stability after total knee arthroplasty. J Arthroplasty 30:587–591

    Article  Google Scholar 

  32. Uvehammer J, Karrholm J, Regner L, Carlsson L, Herberts P (2001) Concave versus posterior-stabilized tibial joint surface in total knee arthroplasty: randomized evaluation of 47 knees. J Arthroplasty 16:25–32

    Article  CAS  Google Scholar 

  33. Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and-substituting total knee arthroplasty. J Bone Joint Surg Br 87:646–655

    Article  CAS  Google Scholar 

  34. Wasielewski RC, Komistek RD, Zingde SM, Sheridan KC, Mahfouz MR (2008) Lack of axial rotation in mobile-bearing knee designs. Clin Orthop Relat Res 466:2662–2668

    Article  Google Scholar 

  35. Yoon JR, Han SB, Jee MK, Shin YS (2017) Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty: a meta-analysis. Medicine (Baltimore) 96:e8157

    Article  Google Scholar 

  36. Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty 20:777–783

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Ms. Jae-Ok Park for her help in preparing the manuscript.

Funding

No funding.

Author information

Author notes

  1. Ji-Hoon Bae and Jung-Ro Yoon have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Ji-Hoon Bae

  2. Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea

    Jung-Ro Yoon, Ju-Hyoung Sung & Young-Soo Shin

Authors
  1. Ji-Hoon Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jung-Ro Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ju-Hyoung Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Young-Soo Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young-Soo Shin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this study, ethical approval is not required.

Informed consent

For this type of study, formal consent is not required.

Additional information

Research of this study was performed at Veterans Health Service Medical Center.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bae, JH., Yoon, JR., Sung, JH. et al. Posterior-stabilized inserts are preferable to cruciate-substituting ultracongruent inserts due to more favourable kinematics and stability. Knee Surg Sports Traumatol Arthrosc 26, 3300–3310 (2018). https://doi.org/10.1007/s00167-018-4872-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-4872-z

Keywords

Search

Navigation