Abstract
This is a prospective assessment of 163 total knee arthroplasties in 130 patients with the retention of both cruciate ligaments of which 107 knees in 89 patients have been followed for ten years. The patients were 34 men and 96 women whose average age, at the time of the index arthroplasty, was 67 years (range: 40 to 84 years). The diagnosis was osteoarthritis in 122 (75%) knees and rheumatoid arthritis in 41 (25%). Twenty-six knees had a valgus deformity, 109 knees a varus deformity and 28 knees had a normal alignment of 5 to 10° of valgus. The anterior cruciate ligament was relatively normal in 96 knees and partly degenerated in 67 knees. Using the Knee Society rating system (37), all 163 knees were prospectively evaluated at yearly intervals including 56 knees in 41 patients who were followed in this manner until they died or were lost to follow-up. 104 knees (97%) of the 107 knees available for study at ten years had excellent or good results. At the latest follow-up in this group of patients, pain was adequately relieved in 97 knees (91%), the average flexion range was 107 ± 12.6° (range: 65 to 135°). Ninety-five knees (89%) had normal antero-posterior stability (less than 5 mm) and 12 knees (11%) had (5 to 10 mm) as determined by the drawer sign. Ninety-six knees (90%) had normal mediolateral stability and 11 knees (10%) had a laxity from 5 to 10°. Ninety-four knees (88%) had a valgus alignment of 5 to 10°. The average knee score was 90.7 ± 8.4 (range: 54 to 100) and the functional score was 82 ± 21 (range: 10 to 100). The survival at ten years with the end point being revision was 94.8% ± 1.95. Seven knees (4.3%) of the 163 knees in this series were revised. There were no revision for patellar problems or aseptic tibial component loosening. The good anteroposterior stability at latest follow-up in this series indicates that both the anterior and posterior cruciate ligaments, even when partly degenerated, remain functional after an average follow-up of ten years.
Similar content being viewed by others
References
Andriacchi T (1981) In vivo evaluation of patient function following total knee replacement. Orthop Trans 5: 416
Andriacchi TP, Galante JO, Fermier RW (1982) The influence of the total knee-replacement design on walking and stair-climbing. J Bone Joint Surg 64-A: 1328–1335
Cloutier JM, Gauthier F (1976) Arthroplastie du genou (prothèse Marmor). Union Med Canada 105: 900–902
Cloutier JM (1983) Results of the total knee arthroplasty with a non-constrained prosthesis. J Bone Jone Surg 64-A: 906–919
Cloutier JM (1991) Long term results after non-constrained total knee arthroplasty. Clin Orthop 273: 63–65
Colliza WA, Insall JN, Scuderi GR (1995) The posterior stabilized total knee prosthesis: Assessment of polyethylene damage and osteolysis after a ten year minimum follow-up. J Bone Joint Surg 77-A: 1713–1720
Dennis DA, Komisek RD, Calwell CW, Scott RD, Thomas T, Ranawat CS (1997) In vivo anteroposterior femoro-tibial translations: A multicentric analysis. Interim Meeting of the Knee Society, New York, 4–5 sept.
Engh GA, Dwyer KA, Hanes CK (1992) Polyethylene wear of metal back tibial components in total and unicompartimental knee prostheses. J Bone Joint Surg 74-B: 9–17
Ewald FC (1989) The knee society total knee arthroplasty evaluation and scoring system. Clin Orthop 248: 9–12
Feng EL, Stueberg SD, Wixson RL (1994) Progressive subluxation and polyethylene wear in total knee replacement with flat articular surface. Clin Orthop 299: 60–71
Freeman MAR, Sculco T, Todd RC (1997) Replacement of the severly damaged knee by the ICLH (Freeman Swanson) arthroplasty. J Bone Joint Surg 59-B: 64–71
Goodfellow J, O'Connor J (1978) The mechanics of the knee and prosthesis design. J Bone Joint Surg 60-B: 358–369
Gunston FH (1971) Polycentric knee arthroplasty. Prosthetic simulation of normal knee movement. J Bone Joint Surg 53-B: 272–277
Gunston FH, MacKenzie RI (1976) Complications of polycentric knee arthroplasty. Clin Orthop 120: 11–17
Insall JN, Dorr LD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop 248: 13–14
Komistek RD (1997) Personal communication, Dec 19
Lew WD, Lewis JL (1982) The effect of knee prosthesis geometry on cruciate ligaments mechanics during fkexion. J Bone Joint Surg 64-A: 734–739
Lewis P, Rorabeck CH, Bourne RB, Devane P (1994) Posteromedial tibial polyethylene failure in total knee replacements. Clin Orthop 299: 11–17
Lindstrand A, Stenstrom A, Lewold S (1992) Multicenter study of unicompartmental knee revision: PCA, Marmor, and St-George compared in 3777 cases of arthrosis. Acta Orthop Scand 63: 256–259
Malkani AL, Rand JA, Bryan RS (1995) Total knee arthroplasty with the kinematic condylar prosthesis: A ten-year follow-up study. J Bone Joint Surg 77-A: 423–431
Mallory TH, Smalley D, Danyi J (1982) Townley anatomic total knee arthropalsty using total tibial component with cruciate release. Clin Orthop 169: 197–201
Marmor L (1993) Unicompartimental arthroplasty for osteonecrosis of the knee joint. Clin Orthop 294: 247–253
Nafei A, Kristensen O, Knudsen HM, Jensen J (1996) Survivorship analysis of cemented total condylar knee arthroplasty. J Arthroplasty 11: 7–10
Nelissen RGHH, Brand R, Rozing PM (1992) Survivorship analysis in total condylar knee arthroplasty. A statical review. J Bone Joint Surg 74-A: 388–389
Nieto JF, Coresh J (1996) Adjusting survival curves for cofouders. A review and a new method. Am J of Epidemiology 143: 1059–1068
Pritchett JW (1993) Anterior cruciate retaining total knee arthroplasty. A 15 year survivorship study. Clin Orthop 286: 96–102
Ranawat CS, Flynn WF, Saddler S, Hansraj KK, Maynard MJ (1993) Long-term results of the total condylar knee arthroplasty. A 15 year survivorship study. Clin Orthop 286: 94–102
Ritter MA, Campbell E, Faris PM, Keating EM (1989) Long-term survival analysis of the posterior cruciate condylar total knee arthroplasty. A 10-year evaluation. J Arthroplasty 4: 293–296
Rodriguez JA, Saddler S, Edelman A, Ranawat CS (1996) Long-term results of total knee arthroplasty in cases 3 and 4 reumatoid arthritis. J Arthroplasty 11: 141–145
Rorabeck CH, Bourne RB, Lewis PL, Nott L (1993) The Miller-Galante knee prosthesis for the treatment of osteonecrosis. A comparison of the results of the partial fixation with cement and fixation without any cement. J Bone Joint Surg 75-A: 402–408
Skolnick MD, Coventry MB, Ilstrup DM (1976) Geometric total knee arthroplasty. A two-year follow-up study. J Bone Joint Surg 58-A: 749–753
Sledge CB, Ewald FC (1979) Total knee arthroplasty experience at the Robert Breck Brigham Hospital. Clin Orthop 145: 78–84
Townley CO (1988) Total knee arthroplasty. A personal retrospective and prospective review. Clin Orthop 236: 8–22
Walker PS, Green D, Reilly D, Thatcher J, Ben Dov M, Ewald FC (1981) Fixation of the tibial components of the knee prosthesis. J Bone Joint Surg 63-A: 258–267
Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns of retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop 299: 31–43
Weir DJ, Moran CG, Pinder IM (1996) Kinematic condylar total knee arthroplasty. 14-year survivorship. J Bone Joint Surg 78-B: 907–911
Whiteside LA (1994) Cementless total knee replacement. Nine to 11 year results and 10 year survivorship analysis. Clin Orthop 309: 185–192
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cloutier, J.M., Sabouret, P. & Deghrar, A. Total knee arthroplasty with retention of both cruciate ligaments. A 9 to 11 year follow-up study. Eur J Orthop Surg Traumatol 11, 41–46 (2001). https://doi.org/10.1007/BF01706663
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01706663