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No difference in patient preference for medial pivot versus posterior-stabilized design in staged bilateral total knee arthroplasty: a prospective study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Medial pivot (MP) TKA has been shown to mimic normal knee kinematics with long-term survivorship comparable to most contemporary TKA. However, there are inadequate evidences to suggest its superiority in terms of patient preference and satisfaction. The aim of this study is to compare the MP with posterior-stabilized (PS) TKA in terms of patient preference and satisfaction.

Methods

46 patients with staged bilateral TKA were recruited. TKA with MP or PS design was performed at interval of 6–12 months. Patient preference, patient satisfaction score (0–100), Forgotten Joint Score (FJS), range of motion (ROM), Pain Score, Knee Society Score (KSS), Knee Function Score (KFS) and WOMAC Score were compared at up to 12 months.

Results

The mean age was 70 and 69.6% were female. There was no difference in all preoperative parameters, operative time and length of stay between two knees. No difference was found in in range of motion and all outcome scores at 6 months and 12 months. Satisfaction score was similar for the two designs (82 vs 85, p = n.s.) at 1 year after the second TKA. Proportion of patients with preference on one design over another was not significantly different (28.9 vs 35.6%, p = n.s.).

Conclusions

There is no evidence to support the superiority of MP TKA over PS TKA in terms of preference and satisfaction. The choice between MP TKA versus PS TKA maybe more a surgeon’s preference than a patient’s preference based on current evidence.

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References

  1. Bae DK, Cho SD, Im SK, Song SJ (2016) Comparison of midterm clinical and radiographic results between total knee arthroplasties using medial pivot and posterior-stabilized prosthesis—a matched pair analysis. J Arthroplasty 31:419–424

    Article  Google Scholar 

  2. Bordini B, Ancarani C, Fitch DA (2016) Long-term survivorship of a medial-pivot total knee system compared with other cemented designs in an arthroplasty registry. J Orthop Surg Res 11:44

    Article  Google Scholar 

  3. Choi NY, In Y, Bae JH, Do JH, Chung SJ, Koh IJ (2017) Are Midterm Patient-reported outcome measures between rotating-platform mobile-bearing prosthesis and medial-pivot prosthesis different? A minimum of 5-year follow-up study. J Arthroplast 32:824–829

    Article  Google Scholar 

  4. Cromie MJ, Siston RA, Giori NJ, Delp SL (2008) Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty. J Orthop Res 26:1494–1499

    Article  Google Scholar 

  5. Fitch DA, Sedacki K (2014) Yang Y (2014) Mid- to long-term outcomes of a medial-pivot system for primary total knee replacement: a systematic review and meta-analysis. Bone Joint Res 3:297–304

    Article  CAS  Google Scholar 

  6. Gibon E, Goodman MJ, Goodman SB (2017) Patient satisfaction after total knee arthroplasty: a realistic or imaginary goal? Orthop Clin N Am 48:421–431

    Article  Google Scholar 

  7. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854–3860

    Article  Google Scholar 

  8. Insall JN (1984) Total knee replacement. In: Insall JN, Ed 1. Surgery Of the Knee. New York: Churchchill Livingstone, 587–696.

  9. Karachalios T, Varitimidis S, Bargiotas K, Hantes M, Roidis N, Malizos KN (2016) An 11- to 15-year clinical outcome study of the Advance Medial Pivot total knee arthroplasty: pivot knee arthroplasty. Bone Joint J 98-B:1050–1055

  10. Kim Y-H, Yoon S-H, Kim J-S (2009) Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis. Clin Orthop Relat Res 467:493–503

    Article  Google Scholar 

  11. Kim YH, Park JW, Kim JS (2017) Clinical outcome of medial pivot compared with press-fit condylar sigma cruciate-retaining mobile-bearing total knee arthroplasty. J Arthroplasty 32:3016–3023

    Article  Google Scholar 

  12. Macheras GA, Galanakos SP, Lepetsos P, Anastasopoulos PP, Papadakis SA (2017) A long term clinical outcome of the medial pivot knee arthroplasty system. Knee 24:447–453

    Article  Google Scholar 

  13. Moonot P, Mu S, Railton GT, Field RE, Banks SA (2009) Tibiofemoral kinematic analysis of knee flexion for a medial pivot knee. Knee Surg Sports Traumatol Arthrosc 17:927–934

    Article  Google Scholar 

  14. Most E, Zayontz S, Li G, Otterberg E, Sabbag K, Rubash HE (2003) Femoral rollback after cruciate-retaining and stabilizing total knee arthroplasty. Clin Orthop Relat Res 410:101–113

    Article  Google Scholar 

  15. Nakamura S, Minoda Y, Nakagawa S, Kadoya Y, Takemura S, Kobayashi A, Mizokawa S, Ohta Y, Takahashi S, Yamamura K et al (2017) Clinical results of alumina medial pivot total knee arthroplasty at a minimum follow-up of 10 years. Knee 24:434–438

    Article  Google Scholar 

  16. Nam D, Nunley RM, Barrack RL (2014) Patient dissatisfaction following total knee replacement: a growing concern? Bone Joint J 96-B:96–100

  17. Nishio Y, Onodera T, Kasahara Y, Takahashi D, Iwasaki N, Majima T (2014) Intraoperative medial pivot affects deep knee flexion angle and patient-reported outcomes after total knee arthroplasty. J Arthroplasty 29:702–706

    Article  Google Scholar 

  18. Nishitani K, Furu M, Nakamura S, Kuriyama S, Ishikawa M, Ito H, Matsuda S (2018) No differences in patient-reported outcomes between medial pivot insert and symmetrical insert in total knee arthroplasty: a randomized analysis. Knee 25:1254–1261

    Article  Google Scholar 

  19. Pandit H, Ward T, Hollinghurst D, Beard DJ, Gill HS, Thomas NP, Murray DW (2005) Influence of surface geometry and the cam-post mechanism on the kinematics of total knee replacement. J Bone Joint Surg (Br) 87:940–945

    Article  CAS  Google Scholar 

  20. Pritchett JW (2011) Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplasty 26:224–228

    Article  Google Scholar 

  21. Ramappa M (2015) Midflexion instability in primary total knee replacement: a review. Sicot J 1:24

    Article  Google Scholar 

  22. Samy DA, Wolfstadt JI, Vaidee I, Backstein DJ (2018) A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient-reported and radiographic outcomes. J Arthroplasty 33:1379–1383

    Article  Google Scholar 

  23. Schmidt R, Komistek RD, Blaha JD, Penenberg BL, Maloney WJ (2003) Fluoroscopic analyses of cruciate-retaining and medial pivot knee implants. Clin Orthop Relat Res 410:139–147

    Article  Google Scholar 

  24. Warth LC, Ishmael MK, Deckard ER, Ziemba-Davis M, Meneghini RM (2017) Do medial pivot kinematics correlate with patient-reported outcomes after total knee arthroplasty? J Arthroplasty 32:2411–2416

    Article  Google Scholar 

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This study and all authors have received no funding.

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Correspondence to Qunn Jid Lee.

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Lee, Q.J., Wai Yee, E.C. & Wong, Y.C. No difference in patient preference for medial pivot versus posterior-stabilized design in staged bilateral total knee arthroplasty: a prospective study. Knee Surg Sports Traumatol Arthrosc 28, 3805–3809 (2020). https://doi.org/10.1007/s00167-020-05867-z

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