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Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to compare the posterior tibial translation after ultracongruent (UC) and posterior-stabilized (PS) total knee arthroplasty (TKA) with two different UC with different heights in the anterior lip, and two different PS designs. This study also aimed to compare the range of motion (ROM) and outcomes scores after the use of these TKA models. It was hypothesised less posterior tibial translation after PS than after UC TKA, and less posterior tibial translation with a higher anterior lip in the UC insert than with a lower one.

Methods

It was designed as a prospective randomized study of a group of 120 patients operated with a cemented TKA. To clarify the main purpose of the study, four groups were analysed using different polyethylene designs: Triathlon PS insert in group one, Triathlon UC insert in group two, U2 PS insert in group three and U2 UC insert in group four. One year after surgery, a forced posterior drawer with a Telos Stress applying 15 kg of force posteriorly on the proximal tibia at 90° of knee flexion was analysed in the lateral radiograph. Limb alignment, tibial posterior slope and posterior condylar offset were also studied.

Results

30 patients were included in each group. The average age was 73 years. There were 72.2% female and 27.8% male patients. There were no significant differences in any demographic or radiographic studied variables, preoperative range of motion (ROM) or preoperative Knee Society Scores (KSS) among the different groups. One year after surgery, the average postoperative ROM and the postoperative KSS Knee and KSS Function scores improved in respect of the preoperative values in all the groups. There were no significant differences in the postoperative outcome scores among the different groups (p = n.s.). Postoperative alignment of the limb, tibial posterior slope and posterior condylar offset were similar in the 4 study groups (p = n.s.). The postoperative posterior tibial translation was different between groups: the PS groups (groups 1 and 3) showed significant inferior values (p < 0.001) in respect of the UC groups (groups 2 and 4). There were no differences between both groups of PS models, but there was a significant increase in the posterior tibial translation of the Triathlon UC insert (11.2 mm SD 3.2) in respect of the U2 UC insert (6.1 mm SD 4.5) (p = 0.004).

Conclusions

UC inserts restrict the posterior tibial translation after TKA less than PS inserts, but a design with a high anterior lip in the polyethylene UC insert can better control the posterior tibial translation than an insert with a small anterior lip.

Level of evidence

Level I. Randomised controlled trial.

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Acknowledgements

The authors would like to thank Xavier Duran from Institut Hospital del Mar d’Investigacions Mèdiques (IMIM) of Barcelona for his help in the methodological advice and statistical analysis.

Funding

No funding has received related to this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l’Esperança, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain

    Pedro Hinarejos, Juan Sánchez-Soler, Raul Torres-Claramunt & Juan Carlos Monllau

  2. Universitat Autonoma de Barcelona, Barcelona, Spain

    Pedro Hinarejos & Juan Carlos Monllau

  3. Department of Orthopedic Surgery, Hospital d’Igualada, Consorci Sanitari de L’Anoia, Av. Catalunya, 11, 08700, Igualada Barcelona, Spain

    Joan Leal-Blanquet

  4. Department of Orthopedic Surgery, Hospital Sant Camil, Ronda Sant Camil S/N, 08810, Sant Pere de Ribes, Barcelona, Spain

    Anna Fraile-Suari

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  1. Pedro Hinarejos
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Correspondence to Pedro Hinarejos.

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Conflict of interest

Dr. Hinarejos and Dr. Leal-Blanquet have perceived fees as scientific consultants by Medcomtech. Dr. Hinarejos has perceived fees for scientific presentations by Stryker.

Ethical approval

The present study received IRB approval by the Parc de Salut Mar Ethical Committee (2017/7170/I).

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Hinarejos, P., Leal-Blanquet, J., Fraile-Suari, A. et al. Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 30, 3041–3048 (2022). https://doi.org/10.1007/s00167-021-06710-9

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