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Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants. From a patient-centred view, bicruciate-retaining models provide a more natural feeling knee. However, there is no evidence of functional advantage for these implants. The aim of this study was to evaluate balance ability as a measure of proprioception in patients with a bicruciate-retaining total knee arthroplasty.

Methods

A prospective, controlled trial was conducted to compare balance ability in 60 patients after arthroplasty of the knee for osteoarthritis. We compared patients with a bicruciate-retaining knee arthroplasty (BCR group) to a control group of patients with a medial unicompartmental knee arthroplasty (UKA group) and another control group of patients with a posterior stabilized total knee arthroplasty (PS group). The patient population comprised 30 women (50.0 %) and 30 men in three cohorts of 20 each. The mean age was 62.1 ± 8.0 years (range 43–78). Patients were evaluated preoperatively and 9 months post-operatively. The evaluation included clinical, radiological, and balance testing—a single-leg stance with eyes closed compared to eyes open. The difference in area of sway between eyes closed and eyes open represents static balance ability after knee arthroplasty.

Results

Perioperative data showed that there was no intra-operative fracture of the intercondylar eminence. There was a decreased post-operative knee extension 9 months post-operative in the BCR group, which was not clinically relevant in any case. We recorded a lower difference in the area of sway between eyes closed and eyes open (ΔA (ec–eo)) for the BCR group (p = 0.01) and the UKA group (p = 0.04) compared to the PS group.

Conclusions

This study found superior static balance ability after preservation of both cruciate ligaments in arthroplasty of the knee, indicating superior proprioceptive function. Hence, BCR implants could provide improved functional properties. Superior proprioceptive function of bicruciate-retaining implants can be an important factor in implant selection. Further prospective, randomized studies to investigate kinematics and long-term survivorship of bicruciate-retaining implants are needed.

Level of evidence

II.

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Authors and Affiliations

  1. Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany

    Florian Baumann, Werner Krutsch, Johannes Zellner, Michael Nerlich & Peter Angele

  2. Sporthopaedicum Regensburg, Hildegard-vn-Bingen-Str. 1, 93053, Regensburg, Germany

    Özkan Bahadin & Peter Angele

  3. Sporthopaedicum Straubing, Bahnhofsplatz 27, 94315, Straubing, Germany

    Carsten Oliver Tibesku

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  1. Florian Baumann
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  2. Özkan Bahadin
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Correspondence to Florian Baumann.

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Baumann, F., Bahadin, Ö., Krutsch, W. et al. Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 1697–1704 (2017). https://doi.org/10.1007/s00167-016-4121-2

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