Skip to main content

Bicruciate-retaining total knee arthroplasty non-inferior to posterior-stabilized prostheses after 5 years: a randomized, controlled trial

Knee Surgery, Sports Traumatology, Arthroscopy volume 31, pages 1034–1042 (2023)Cite this article

Abstract

Purpose

Bicruciate-retaining (BCR) prostheses may improve satisfaction of patient undergoing total knee arthroplasty (TKA). The objective of this randomized controlled trial was to assess whether BCR prostheses provide better clinical outcomes than posterior-stabilized (PS) prostheses.

Materials and methods

This is a randomized single-blind control trial involving a total of 77 patients with knee osteoarthritis, randomly assigned to undergo TKA with a BCR or PS implant between 2015 and 2019. Mean follow-up period was 39 months. Clinical and demographic data were extracted manually from medical records. Data acquisition included patient demographics, knee range of motion, and patient-reported outcomes via KSS, KOOS, WOMAC, and SF-12 scores.

Results

A total of 38 patients were randomized to the PS group and 39 to the BCR group. At the 5-year follow-up, no statistical differences were noted for knee range of motion or patient-reported outcomes between the two groups, except for a greater knee flexion in the early follow-up period in the PS group. Five adverse events occurred in the BCR group compared to none in the PS group (p = 0.02).

Conclusion

BCR TKA yield similar clinical and patient-reported outcomes 5 years following the intervention compared with PS TKA. The BCR TKA had more complications.

Level of evidence

I (Randomized Controlled Trial).

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3

References

  1. Allain J, Goutallier D, Voisin MC (2001) Macroscopic and histological assessments of the cruciate ligaments in arthrosis of the knee. Acta Orthop Scand 72:266–269

    Article  CAS  PubMed  Google Scholar 

  2. Alnachoukati OK, Emerson RH, Diaz E, Ruchaud E, Ennin KA (2018) Modern day bicruciate-retaining total knee arthroplasty: a short-term review of 146 knees. J Arthroplasty 33:2485–2490

    Article  PubMed  Google Scholar 

  3. Arauz P, Klemt C, Limmahakhun S, An S, Kwon Y-M (2019) Stair climbing and high knee flexion activities in bi-cruciate retaining total knee arthroplasty: in vivo kinematics and articular contact analysis. J Arthroplasty 34:570–576

    Article  PubMed  Google Scholar 

  4. Arauz P, Peng Y, Kwon Y-M (2018) Knee motion symmetry was not restored in patients with unilateral bi-cruciate retaining total knee arthroplasty—in vivo three-dimensional kinematic analysis. Int Orthop 42:2817–2823

    Article  PubMed  Google Scholar 

  5. Arnout N, Victor J, Vermue H, Pringels L, Bellemans J, Verstraete M (2020) Knee joint laxity is restored in a bi-cruciate retaining TKA-design. Knee Surg Sports Traumatol Arthrosc 28:2863–2871

    Article  CAS  PubMed  Google Scholar 

  6. Barrett TJ, Shi L, Parsley BS (2017) Bicruciate-retaining total knee arthroplasty, a promising technology, that’s not quite there. Ann of transl med 5:S17–S17

    Article  Google Scholar 

  7. Baumann F, Bahadin O, Krutsch W, Zellner J, Nerlich M, Angele P et al (2017) Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:1697–1704

    Article  PubMed  Google Scholar 

  8. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    Article  PubMed  Google Scholar 

  9. Buechel FF, Pappas MJ (1990) Long-term survivorship analysis of cruciate-sparing versus cruciate-sacrificing knee prostheses using meniscal bearings. Clin Orthop Relat Res 1:162–169

    Google Scholar 

  10. Christensen JC, Brothers J, Stoddard GJ, Anderson MB, Pelt CE, Gililland JM et al (2017) Higher frequency of reoperation with a new bicruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 475:62–69

    Article  PubMed  Google Scholar 

  11. Clement N, Weir D, Holland J, Gerrand C, Deehan D (2019) Meaningful changes in the Short Form 12 physical and mental summary scores after total knee arthroplasty. Knee 26:861–868

    Article  CAS  PubMed  Google Scholar 

  12. Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ (2018) What is the minimum clinically important difference for the WOMAC index after TKA? Clin Orthop Relat Res 476:2005

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cloutier JM, Sabouret P, Deghrar A (1999) Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study. J Bone Joint Surg Am 81:697–702

    Article  CAS  PubMed  Google Scholar 

  14. Cushner FD, La Rosa DF, Vigorita VJ, Scuderi GR, Scott WN, Insall JN (2003) A quantitative histologic comparison: ACL degeneration in the osteoarthritic knee. J Arthroplasty 18:687–692

    Article  PubMed  Google Scholar 

  15. Dalury DF, Fisher DA, Adams MJ, Gonzales RA (2009) Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient. Orthopedics 32:1213–1226

    Google Scholar 

  16. De Faoite D, Ries C, Foster M, Boese CK (2020) Indications for bi-cruciate retaining total knee replacement: an international survey of 346 knee surgeons. PLoS ONE 15:e0234616

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 468:102–107

    Article  PubMed  Google Scholar 

  18. Douglas M, Hutchison J, Sutherland A (2010) Anterior cruciate ligament integrity in osteoarthritis of the knee in patients undergoing total knee replacement. J Trauma 11:149–154

    CAS  Google Scholar 

  19. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJ, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854–3860

    Article  PubMed  Google Scholar 

  20. Halewood C, Traynor A, Bellemans J, Victor J, Amis AA (2015) Anteroposterior laxity after bicruciate-retaining total knee arthroplasty is closer to the native knee than acl-resecting tka: a biomechanical cadaver study. J Arthroplasty 30:2315–2319

    Article  PubMed  Google Scholar 

  21. Heesterbeek PJ, Jacobs WC, Wymenga AB (2009) Effects of the balanced gap technique on femoral component rotation in TKA. Clin Orthop Relat Res 467:1015–1022

    Article  PubMed  Google Scholar 

  22. Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197

    Article  Google Scholar 

  23. Keyes GW, Carr AJ, Miller RK, Goodfellow JW (1992) The radiographic classification of medial gonarthrosis: correlation with operation methods in 200 knees. Acta Orthop Scand 63:497–501

    Article  CAS  PubMed  Google Scholar 

  24. Komistek RD, Allain J, Anderson DT, Dennis DA, Goutallier D (2002) In vivo kinematics for subjects with and without an anterior cruciate ligament. Clin Orthop Relat Res 404:315–325

    Article  Google Scholar 

  25. Lavoie F (2017) Spacer-based gap balancing in total knee arthroplasty: clinical success with a reproducible technique. J Knee Surg 30:798–806

    Article  PubMed  Google Scholar 

  26. Lavoie F, Al-Shakfa F, Moore JR, Mychaltchouk L, Iguer K (2018) Postoperative stiffening after bicruciate-retaining total knee arthroplasty. J Knee Surg 31:453–458

    Article  PubMed  Google Scholar 

  27. Lyman S, Lee YY, McLawhorn AS, Islam W, MacLean CH (2018) What are the minimal and substantial improvements in the HOOS and KOOS and JR versions after total joint replacement? Clin Orthop Relat Res 476:2432–2441

    Article  PubMed  PubMed Central  Google Scholar 

  28. Moro-oka TA, Muenchinger M, Canciani JP, Banks SA (2007) Comparing in vivo kinematics of anterior cruciate-retaining and posterior cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15:93–99

    Article  PubMed  Google Scholar 

  29. Nam D, Nunley R, Barrack R (2014) Patient dissatisfaction following total knee replacement: a growing concern? Bone Joint J 96:96–100

    Article  PubMed  Google Scholar 

  30. Parcells BW, Tria AJ Jr (2016) The cruciate ligaments in total knee arthroplasty. Am J Orthop (Belle Mead NJ) 45:153–160

    Google Scholar 

  31. Pelt CE, Sandifer PA, Gililland JM, Anderson MB, Peters CL (2019) Mean three-year survivorship of a new bicruciate-retaining total knee arthroplasty: are revisions still higher than expected? J Arthroplasty 34:1957–1962

    Article  PubMed  Google Scholar 

  32. Pritchett JW (2015) Bicruciate-retaining total knee replacement provides satisfactory function and implant survivorship at 23 years. Clin Orthop Relat Res 473:2327–2333

    Article  PubMed  PubMed Central  Google Scholar 

  33. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    Article  CAS  PubMed  Google Scholar 

  34. Roos EM, Toksvig-Larsen S (2003) Knee injury and Osteoarthritis Outcome Score (KOOS)–validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:1–10

    Article  Google Scholar 

  35. Sabouret P, Lavoie F, Cloutier J (2013) Total knee replacement with retention of both cruciate ligaments: a 22-year follow-up study. Bone Joint J 95:917–922

    Article  PubMed  Google Scholar 

  36. Serna-Berna R, Lizaur-Utrilla A, Vizcaya-Moreno MF, Muñoz FAM, Gonzalez-Navarro B, Lopez-Prats FA (2018) Cruciate-retaining vs posterior-stabilized primary total arthroplasty. Clinical outcome comparison with a minimum follow-up of 10 years. J Arthroplasty 33:2491–2495

    Article  PubMed  Google Scholar 

  37. Troelsen A, Ingelsrud LH, Thomsen MG, Muharemovic O, Otte KS, Husted H (2020) Are there differences in micromotion on radiostereometric analysis between bicruciate and cruciate-retaining designs in TKA? A randomized controlled trial. Clin Orthop Relat Res 478:2045–2053

    Article  PubMed  Google Scholar 

  38. Ware JE Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med care 34:220–233

    Article  PubMed  Google Scholar 

  39. Wylde V, Beswick A, Bruce J, Blom A, Howells N, Gooberman-Hill R (2018) Chronic pain after total knee replacement. EFORT Open Rev 3:461–470

    Article  PubMed  PubMed Central  Google Scholar 

  40. Yang HY, Seon JK, Shin YJ, Lim HA, Song EK (2017) Robotic total knee arthroplasty with a cruciate-retaining implant: a 10-year follow-up study. Clin Orthop Surg 9:169–176

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Centre hospitalier de l’Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada

    Frédéric Lavoie, Antoine Denis, Sami Chergui, Fidaa Al-Shakfa & Pierre Sabouret

Authors
  1. Frédéric Lavoie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antoine Denis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sami Chergui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fidaa Al-Shakfa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierre Sabouret
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frédéric Lavoie.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare associated with this publication.

Ethical approval

All patients consented to participate in the study. The study was approved by our local ethics board (approval number: 10.068) and was registered at ClinicalTrials.gov (NCT05469776).

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lavoie, F., Denis, A., Chergui, S. et al. Bicruciate-retaining total knee arthroplasty non-inferior to posterior-stabilized prostheses after 5 years: a randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 31, 1034–1042 (2023). https://doi.org/10.1007/s00167-022-07210-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07210-0

Keywords

  • Knee osteoarthritis
  • Arthroplasty
  • Bicruciate-retaining
  • Posterior-stabilized
  • Randomized controlled trial