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PCL retention demonstrates better functional scores and gait patterns in total knee arthroplasty using a medial congruent insert—a prospective study

  • KNEE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite Total Knee Arthroplasty (TKA) being one of the most successful procedures for end stage arthritis, nearly 20% of patients undergoing this procedure remain dissatisfied. Various design options have been introduced to reduce this cohort of patients. One such option has been the introduction of the medial congruent (MC) polyethylene design. This study was undertaken to evaluate outcome measures and gait analysis in patients undergoing bilateral single stage TKA where the posterior cruciate ligament (PCL) was retained or excised in contralateral knees.

Methods

60 bilateral TKA’s were performed by a single surgeon using a MC design option from July to Sep 2021. The study lots included patients between the ages of 55 and 70 years with fixed varus deformity of degenerative aetiology, and Kellgren Lawrence Grade 3 and 4 radiological changes. Exclusion criteria were previous surgery to the lower extremities, sero positive arthropathies, post traumatic arthritis, valgus deformity, flexion contractures > 20°, and any pre-existing pathology impacting gait, e.g., poliomyelitis, or neuromuscular disorders. The PCL was retained or sacrificed on contralateral sides for the purpose of this study. Functional scores, outcomes and gait analysis on level and gradient walking were evaluated at a follow-up of 18 months.

Results

At 18, months the Range of Motion (ROM) improved from a preoperative value of 97.3 ± 11.5 to 110.3 ± 6.1 on the PCL retained side (MC-PCL) and from 96.5 ± 10.8 to 113 ± 5.8 on the PCL excised side (MC-PCLX). Knee Society Score (KSS-2011) improved from a preoperative value of 21.2 ± 4.5 to 89.8 ± 3.4 at 18 months postoperatively on the MC-PCL side and from 21.5 ± 4 to 88.2 ± 3.7 on the MC-PCLX side. Forgotten Joint Score (FJS-12) was 8.8 ± 0.7 on the MC-PCL side and 8.1 ± 0.9 on the MC-PCLX side 18 months after surgery. Our gait analysis evaluation demonstrated a lower forefoot pressure in the MC-PCL group in comparison to the MC-PCLX group when subjects were made to walk on a 30° upward incline. This difference was found to be statistically significant.

Conclusion

In this study, while ROM was greater in the MC-PCLX study lot, patient satisfaction was higher in the MC-PCL study lot. Gait assessment demonstrated lower forefoot pressure while ascending an incline of 30° in the MC-PCL study lot as compared to the MC-PCLX study lot approximating normal gait patterns.

Level of evidence

II.

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Data availability

Relevant data is available and can be provided on request.

Abbreviations

TKA:

Total knee arthroplasty

MC:

Medial congruent

PS:

Posterior stabilizing

CR:

Cruciate retaining

PCL:

Posterior cruciate ligament

ROM:

Range of motion

KSS:

Knee society score

OKS:

Oxford knee score

FJS:

Forgotten joint score

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Acknowledgements

Nil.

Funding

This study did not require any funding.

Author information

Authors and Affiliations

  1. Medanta- The Medicity Hospital, Gurugram, Haryana, 122001, India

    Ashok Rajgopal, Sumit Kumar, Manish Kumar Singh & Kalpana Aggarwal

Authors
  1. Ashok Rajgopal
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  2. Sumit Kumar
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  3. Manish Kumar Singh
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  4. Kalpana Aggarwal
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Contributions

AR- study concept, design and editing. SK and KA (PT)- writing original draft- review and editing. MKS- data curation.

Corresponding author

Correspondence to Ashok Rajgopal.

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Conflict of interest

The corresponding author receives Royalties from Zimmer Biomet and Meril. No other author has any conflict of interest.

Ethical approval

The study was approved by the Medanta Institutional Review Board.

Informed consent

Informed consent was taken from all the patients.

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Rajgopal, A., Kumar, S., Singh, M.K. et al. PCL retention demonstrates better functional scores and gait patterns in total knee arthroplasty using a medial congruent insert—a prospective study. Knee Surg Sports Traumatol Arthrosc 31, 4741–4746 (2023). https://doi.org/10.1007/s00167-023-07499-5

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  • DOI: https://doi.org/10.1007/s00167-023-07499-5

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