No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial

Abstract

Purpose

Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCL-sacrificing TKA.

Methods

Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no significant differences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups.

Results

There were no significant differences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no significant differences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and flexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05).

Conclusion

The use of UC or PS inserts in TKA did not affect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential differences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacrificing the PCL in TKA.

Level of evidence

I.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Akkawi I, Colle F, Bruni D, Raspugli GF, Bignozzi S, Zaffagnini S et al (2015) Deep-dished highly congruent tibial insert in CR-TKA does not prevent patellar tendon angle increase and patellar anterior translation. Knee Surg Sports Traumatol Arthrosc 23:1622–1630. https://doi.org/10.1007/s00167-014-2889-5

    Article  PubMed  Google Scholar 

  2. 2.

    Appy Fedida B, 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. https://doi.org/10.1016/j.otsr.2015.07.024

  3. 3.

    Bae JH, Yoon JR, Sung JH, Shin YS (2018) 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. https://doi.org/10.1007/s00167-018-4872-z

    Article  PubMed  Google Scholar 

  4. 4.

    Bercik MJ, Joshi A, Parvizi J (2013) Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a meta-analysis. J Arthroplasty 28:439–444. https://doi.org/10.1016/j.arth.2012.08.008

    Article  PubMed  Google Scholar 

  5. 5.

    Daniilidis K, Skwara A, Vieth V, Fuchs-Winkelmann S, Heindel W, Stückmann 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. https://doi.org/10.1016/j.knee.2011.04.001

    Article  PubMed  Google Scholar 

  6. 6.

    Emerson RH Jr, Barrington JW, Olugbode SA, Alnachoukati OK (2016) A comparison of 2 tibial inserts of different constraint for cruciate-retaining primary total knee arthroplasty: an additional tool for balancing the posterior cruciate ligament. J Arthroplasty 31:425–428. https://doi.org/10.1016/j.arth.2015.09.032

    Article  PubMed  Google Scholar 

  7. 7.

    Fritzsche H, Beyer F, Postler A, Lützner J (2018) Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:1465–1470. https://doi.org/10.1007/s00167-017-4427-8

    Article  PubMed  Google Scholar 

  8. 8.

    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 13–14

  9. 9.

    Jang SW, Kim MS, Koh IJ, Sohn S, Kim C, In Y (2019) Comparison of anterior-stabilized and posterior-stabilized total knee arthroplasty in the same patients: a prospective randomized study. J Arthroplasty 34:1682–1689. https://doi.org/10.1016/j.arth.2019.03.062

    Article  PubMed  Google Scholar 

  10. 10.

    Kim JG, Lee SW, Ha JK, Choi HJ, Yang SJ, Lee MY (2011) The effectiveness of minimally invasive total knee arthroplasty to preserve quadriceps strength: a randomized controlled trial. Knee 18:443–447. https://doi.org/10.1016/j.knee.2010.08.008

    Article  PubMed  Google Scholar 

  11. 11.

    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. https://doi.org/10.1007/s00167-014-3489-0

    Article  PubMed  Google Scholar 

  12. 12.

    Lacko M, Schreierová D (2019) Comparison of survival rate and risk of revision for mobile-bearing and fixed-bearing total knee replacements. Eklem Hastalik Cerrahisi 30:70–78. https://doi.org/10.5606/ehc.2019.62830

    Article  PubMed  Google Scholar 

  13. 13.

    Lee SS, Kim JH, Heo JW, Moon YW (2019) Gradual change in knee extension following total knee arthroplasty using ultracongruent inserts. Knee 26:905–913. https://doi.org/10.1016/j.knee.2019.06.001

    Article  PubMed  Google Scholar 

  14. 14.

    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. https://doi.org/10.1007/s00167-012-2275-0

    Article  PubMed  Google Scholar 

  15. 15.

    Lienhard K, Lauermann SP, Schneider D, Item-Glatthorn JF, Casartelli NC, Maffiuletti NA (2013) Validity and reliability of isometric, isokinetic and isoinertial modalities for the assessment of quadriceps muscle strength in patients with total knee arthroplasty. J Electromyogr Kinesiol 23:1283–1288. https://doi.org/10.1016/j.jelekin.2013.09.004

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Lützner J, Beyer F, Dexel J, Fritzsche H, Lützner C, Kirschner S (2017) 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. https://doi.org/10.1007/s00167-016-4331-7

    Article  PubMed  Google Scholar 

  17. 17.

    Lützner J, Firmbach FP, 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. https://doi.org/10.1007/s00167-014-2892-x

    Article  PubMed  Google Scholar 

  18. 18.

    Maffiuletti NA, Bizzini M, Widler K, Munzinger U (2010) Asymmetry in quadriceps rate of force development as a functional outcome measure in TKA. Clin Orthop Relat Res 468:191–198. https://doi.org/10.1007/s11999-009-0978-4

    Article  PubMed  Google Scholar 

  19. 19.

    Matziolis G, Mehlhorn S, Schattat N, Diederichs G, Hube R, Perka C et al (2012) How much of the PCL is really preserved during the tibial cut? Knee Surg Sports Traumatol Arthrosc 20:1083–1086. https://doi.org/10.1007/s00167-011-1696-5

    Article  PubMed  Google Scholar 

  20. 20.

    Nguyen LC, Lehil MS, Bozic KJ (2015) Trends in total knee arthroplasty implant utilization. J Arthroplasty 30:739–742. https://doi.org/10.1016/j.arth.2014.12.009

    Article  PubMed  Google Scholar 

  21. 21.

    Omori G, Onda N, Shimura M, Hayashi T, Sato T, Koga Y (2009) The effect of geometry of the tibial polyethylene insert on the tibiofemoral contact kinematics in advance medial pivot total knee arthroplasty. J Orthop Sci 14:754–760. https://doi.org/10.1007/s00776-009-1402-3

    Article  PubMed  Google Scholar 

  22. 22.

    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. https://doi.org/10.1007/s11999-013-3068-6

    Article  PubMed  Google Scholar 

  23. 23.

    Scott DF (2018) Prospective randomized comparison of posterior-stabilized versus condylar-stabilized total knee arthroplasty: final report of a five-year study. J Arthroplasty 33:1384–1388. https://doi.org/10.1016/j.arth.2017.11.037

    Article  PubMed  Google Scholar 

  24. 24.

    Sole G, Hamrén J, Milosavljevic S, Nicholson H, Sullivan SJ (2007) Test-retest reliability of isokinetic knee extension and flexion. Arch Phys Med Rehabil 88:626–631. https://doi.org/10.1016/j.apmr.2007.02.006

    Article  PubMed  Google Scholar 

  25. 25.

    Song EK, Lim HA, Joo SD, Kim SK, Lee KB, Seon JK (2017) Total knee arthroplasty using ultra-congruent inserts can provide similar stability and function compared with cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3530–3535. https://doi.org/10.1007/s00167-017-4553-3

    Article  PubMed  Google Scholar 

  26. 26.

    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. https://doi.org/10.1016/j.arth.2014.11.018

    Article  PubMed  Google Scholar 

  27. 27.

    Wang XF, Ma ZH, Teng XR (2020) Isokinetic strength test of muscle strength and motor function in total knee arthroplasty. Orthop Surg 12:878–889. https://doi.org/10.1111/os.12699

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Yoon JR, Yang JH (2018) Satisfactory short-term results of navigation-assisted gap-balancing total knee arthroplasty using ultracongruent insert. J Arthroplasty 33:723–728. https://doi.org/10.1016/j.arth.2017.09.049

    Article  PubMed  Google Scholar 

Download references

Funding

The authors received no specific funding for this work.

Author information

Affiliations

Authors

Contributions

The study was conceived by D.C. D.C. performed all the surgeries. D.K. performed all the isokinetic tests. D.C., E.A.S. and S.A. performed the analyses and D.C. and E.A.S. wrote the initial draft. All authors contributed to the interpretation of the data and to revision of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Sefa Akti.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board (IRB) by the “Ankara Numune Training and Research Hospital Clinical Research Ethics Committee” ethical committee (1585/2017) and was performed in accordance to the 1964 Helsinki Declaration and its amendments.

Informed consent

Written informed consent was acquired for all participants prior to their participation.

Trial registration number and date of registration

ClinicalTrials.gov NCT04419311, 05 June 2020 (Retrospectively registered).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Akti, S., Karakus, D., Sezgin, E.A. et al. No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-06275-z

Download citation

Keywords

  • Ultra-congruent
  • Insert
  • Isokinetic
  • Total knee replacement
  • Posterior stabilized