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Favorable outcomes of posterior cruciate-stabilized inserts over ultracongruent inserts in total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

Posterior cruciate-stabilized (PS) and ultracongruent (UC) inserts are used during total knee arthroplasty (TKA), but superiority in gaining postoperative knee flexion and functionality remains contested. Therefore, this study compared postoperative outcomes between PS and UC inserts.

Methods

A retrospective review evaluated unilateral or bilateral TKAs with PS or UC inserts from August 2011 to March 2020. Nonparametric statistics were performed to evaluate differences in patient demographics, pre- and postknee flexion and Knee Society Knee (KSS-K) and Function Score (KSS-F). Univariate and multivariable regressions were performed to evaluate the influence on postoperative knee flexion ≥ 120°, presented as odds ratios (OR) and 95% confidence intervals (CI).

Results

Patient demographics were not significantly different between the 577 PS and 399 UC knees evaluated. Postoperatively, a larger proportion of UC knees demonstrated knee flexion < 120° (36.0% vs. 18.6%, p < 0.001) and lower KSS-K (91.0 ± 8.7 vs. 91.6 ± 10.3, p < 0.001) and KSS-F (76.8 ± 21.6 vs. 79.9 ± 21.6, p = 0.007) than the PS group. The PS group had greater improvement in flexion angle (4.9° ± 14.9° vs. 1.0° ± 15.6°, p < 0.001) and KSS-F (27.3 ± 23.3 vs. 23.1 ± 25.3, p = 0.007) as compared to that of UC patients. Patients with preoperative flexion < 120° (OR 2.787, CI 2.066–3.761; p < 0.001), higher body mass index (OR 1.033, CI 1.006–1.061; p = 0.017) and UC insert (OR 2.461, CI 1.832–3.307; p < 0.001) were less likely to achieve flexion ≥ 120°.

Conclusion

Favorable clinical and functional outcomes were noted in the PS group as compared to UC inserts in TKA. The greater improvement in overall knee flexion may suggest the PS insert may be especially appropriate for patients with lower preoperative range of motion.

Level of evidence

III, retrospective comparative study.

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Data availability

Data for this study is kept in a secure repository and can be accessed with permission for appropriate requests.

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Acknowledgements

The authors would like to thank Samantha N. Andrews Ph.D., ATC, for her contributions regarding statistical analysis and help with student mentoring and manuscript preparation.

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This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Authors and Affiliations

  1. John A. Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Kyle K. Obana, Krystin Wong & Julian Rimm

  2. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA

    Krystin Wong, Brent T. Shimoda & Cass K. Nakasone

  3. Department of Surgery, University of Hawai’i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Cass K. Nakasone

  4. Department of Anatomy, Biochemistry, and Physiology, University of Hawai’i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Christopher D. Stickley

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Correspondence to Cass K. Nakasone.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawai‘i Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

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Obana, K.K., Wong, K., Shimoda, B.T. et al. Favorable outcomes of posterior cruciate-stabilized inserts over ultracongruent inserts in total knee arthroplasty. Arch Orthop Trauma Surg 143, 5857–5865 (2023). https://doi.org/10.1007/s00402-023-04837-7

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