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Clinical relevance of roll-back replacement of ultra congruent total knee arthroplasty: comparison of mid-term outcomes with posterior stabilizing design

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

Abstract

Introduction

The outcomes of total knee arthroplasty (TKA) remain controversial, and we do not know which factors are important for successful outcomes. This study aimed to compare the mid-term outcomes of different conceptual designs by evaluating the radiological and clinical outcomes.

Materials and methods

A total of 478 total knee arthroplasties (TKAs) were enrolled and allocated into groups I [posterior stabilizing (PS) with anterior referencing (AR)], II [PS with posterior referencing (PR), and III [ultra-congruent (UC) TKA)]. Preoperative findings, last follow-up clinical outcomes, and final follow-up radiological and indirect assessments of the femoral rollback were compared between the groups.

Results

The mean follow-up period was 72.6 ± 12.9 months. The tourniquet was used samely applied to every group. Flexion contracture was significantly larger in group III than in groups I and II (3.3 ± 2.7, p < 0.001), and further flexion was significantly smaller in group III (130.0° ± 2.7°, p < 0.001). Among the radiological parameters, posterior osteophyte formation was the most common in group III (67.8%). The rollback distance was significantly smaller in group III than in groups I and II (p < 0.001). The active deep flexion angle was affected by the posterior condylar offset (PCO) ratio, and the contact point changed the distance (p < 0.05).

Conclusion

PS TKAs showed better ROMs than UC TKAs; however, no differences were noted in the clinical outcome scales. The flexion angle was affected by the PCOR and rollback at both PS and UC TKAs. However, rollback negatively affected the flexion angle during UC TKAs. An inappropriate femoral rollback was identified, and femoral osteophyte formation was determined to be the most prominent in UC TKAs.

Level of evidence Level III comparative study.

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Every data was transparency.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Hyun Jin Yoo, Ho Won Jeong, Sung Bae Park, Hee Seung Nam & Yong Seuk Lee

  2. Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea

    Hyun Jin Yoo

  3. Department of Orthopaedic Surgery, Soonchunyang University Hospital, Seoul, Korea

    Yong Beom Kim

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  1. Hyun Jin Yoo
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Contributions

Thanks to all authors. All authors were involved in drafting the article or revising it critically for important intellectual content. All authors approved the final version to be published. Detailed contributions: Study conception and design (HJY, YSL, and HWJ), acquisition and analysis of data (HWJ, HJY, and SBP), discussions and interpretation of data (HJY, YSL, and YBK), and drafting of the article (YSL, HJY). Dr. Yong Seuk Lee (smcos1@hanmail.net) as corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Yong Seuk Lee.

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Institutional Review Board approval was obtained before performing the study (IRB NO: B-2008-633-107).

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Supplementary figure 1

Schematic diagram of contact point distribution (deep blue: at 30° flexion, sky blue: at active deep flexion, black dot line: deepest point), (A) PS (group I and II); (B) UC (group III). Supplementary file1 (TIF 457 KB)

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Yoo, H.J., Kim, Y.B., Jeong, H.W. et al. Clinical relevance of roll-back replacement of ultra congruent total knee arthroplasty: comparison of mid-term outcomes with posterior stabilizing design. Arch Orthop Trauma Surg 143, 6805–6813 (2023). https://doi.org/10.1007/s00402-023-04918-7

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