Skip to main content

Advertisement

SpringerLink
Log in

Comparison of traditional PS versus kinematically designs in primary total knee arthroplasty

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

Abstract

Purpose

Kinematically designed total knee arthroplasty (TKA) aims to restore normal kinematics by replicating the function of both cruciate ligaments. Traditional posterior-stabilized (PS) TKA designs, on the other hand, simplify knee kinematics and may improve TKA cost-effectiveness. The purpose of this study was to compare outcomes of patients who underwent primary TKA using either a traditional PS or kinematically designed TKA.

Methods

This retrospective study examined all patients who underwent primary TKA using either a kinematically or a traditional PS designed TKA implant, with a minimum follow-up of 2 years. Patient demographics, complications, readmissions, revision rates and causes, range of motion (ROM) and patient reported outcomes (KOOS, JR) were compared between groups. Kaplan–Meier survivorship analysis was performed to estimate freedom from revision, and multivariate regression was performed to control for confounding variables.

Results

A total of 396 TKAs [173 (43.7%) with a kinematic design, 223 (56.3%) with a traditional design] with a mean follow-up of 3.48 ± 1.51 years underwent analysis. Revision rates did not differ between groups (9.8% vs. 6.7%, p = 0.418). In Kaplan–Meier analysis at 2-year follow-up, freedom from all-cause revision (96.4% vs. 93.1%, p = 0.139) were similar between groups. The two cohorts had no significant difference in aseptic loosening at 2 years (99.6% vs. 97.1, p = 0.050) and at latest follow up (92.7% vs. 96.4%, p = 0.279). KOOS, JR scores and post-operative ROM were similar between groups.

Conclusion

This study demonstrated similar mid-term outcomes following the use of both a kinematically designed and a traditionally designed implant in primary TKA patients.

Level of evidence

Retrospective study—III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

References

  1. Cram P, Lu X, Kates SL et al (2012) Among Medicare beneficiaries, 1991–2010. JAMA J Am Med Assoc 308:1227–1236

    Article  CAS  Google Scholar 

  2. Becker R, Döring C, Denecke A, Brosz M (2011) Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1433–1441. https://doi.org/10.1007/s00167-011-1621-y

    Article  PubMed  Google Scholar 

  3. Lützner C, Postler A, Beyer F et al (2019) Fulfillment of expectations influence patient satisfaction 5 years after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:2061–2070. https://doi.org/10.1007/s00167-018-5320-9

    Article  PubMed  Google Scholar 

  4. Fransen BL, Pijnappels M, Butter IK et al (2021) Patients’ perceived walking abilities, daily-life gait behavior and gait quality before and 3 months after total knee arthroplasty. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-03915-y

    Article  PubMed  PubMed Central  Google Scholar 

  5. Goh GS, Bin Abd Razak HR, Tay DK-J et al (2021) Early post-operative oxford knee score and knee society score predict patient satisfaction 2 years after total knee arthroplasty. Arch Orthop Trauma Surg 141:129–137. https://doi.org/10.1007/s00402-020-03612-2

    Article  PubMed  Google Scholar 

  6. Lachiewicz PF, Soileau ES (2004) The rates of osteolysis and loosening associated with a modular posterior stabilized knee replacement. J Bone Joint Surg 86:525–530. https://doi.org/10.2106/00004623-200403000-00010

    Article  PubMed  Google Scholar 

  7. Tayot O, Ait Si Selmi T, Neyret P (2001) Results at 11.5 years of a series of 376 posterior stabilized HLS1 total knee replacements. Knee 8:195–205. https://doi.org/10.1016/S0968-0160(01)00098-9

    Article  CAS  PubMed  Google Scholar 

  8. Savov P, Mielke E, Windhagen H et al (2021) Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatment of valgus osteoarthritis. Arch Orthop Trauma Surg 141:305–312. https://doi.org/10.1007/s00402-020-03618-w

    Article  PubMed  Google Scholar 

  9. Dolan MM, Kelly NH, Nguyen JT et al (2011) Implant design influences tibial post wear damage in posterior-stabilized knees. Clin Orthop Relat Res 469:160–167. https://doi.org/10.1007/s11999-010-1515-1

    Article  PubMed  Google Scholar 

  10. Pfitzner T, Moewis P, Stein P et al (2018) Modifications of femoral component design in multi-radius total knee arthroplasty lead to higher lateral posterior femoro-tibial translation. Knee Surg Sports Traumatol Arthrosc 26:1645–1655. https://doi.org/10.1007/s00167-017-4622-7

    Article  PubMed  Google Scholar 

  11. Khasian M, LaCour MT, Coomer SC et al (2020) In vivo knee kinematics for a cruciate sacrificing total knee arthroplasty having both a symmetrical femoral and tibial component. J Arthroplasty 35:1712–1719. https://doi.org/10.1016/j.arth.2020.02.004

    Article  PubMed  Google Scholar 

  12. Christen B, Neukamp M, Aghayev E (2014) Consecutive series of 226 journey bicruciate substituting total knee replacements: Early complication and revision rates. BMC Musculoskelet Disord 15:1–9. https://doi.org/10.1186/1471-2474-15-395

    Article  Google Scholar 

  13. Victor J, Bellemans J (2006) Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res 452:53–58. https://doi.org/10.1097/01.blo.0000238792.36725.1e

    Article  PubMed  Google Scholar 

  14. Grieco TF, Sharma A, Dessinger GM et al (2018) In vivo kinematic comparison of a bicruciate stabilized total knee arthroplasty and the normal knee using fluoroscopy. J Arthroplasty 33:565–571. https://doi.org/10.1016/j.arth.2017.09.035

    Article  PubMed  Google Scholar 

  15. Digennaro V, Zambianchi F, Marcovigi A et al (2014) Design and kinematics in total knee arthroplasty. Int Orthop 38:227–233. https://doi.org/10.1007/s00264-013-2245-2

    Article  PubMed  PubMed Central  Google Scholar 

  16. van Duren BH, Pandit H, Price M et al (2012) Bicruciate substituting total knee replacement: how effective are the added kinematic constraints in vivo? Knee Surg Sports Traumatol Arthrosc 20:2002–2010. https://doi.org/10.1007/s00167-011-1796-2

    Article  PubMed  Google Scholar 

  17. Demcoe AR, Bohm ER, Hedden DR et al (2019) Does oxidized zirconium make a difference? Midterm cohort survivorship of symmetric posterior condyle posterior-stabilized total knee arthroplasty. Can J Surg 62:118–122. https://doi.org/10.1503/cjs.007518

  18. Hommel H, Wilke K (2017) Good early results obtained with a guided-motion implant for total knee arthroplasty: a consecutive case series. Open Orthop J 11:51–56. https://doi.org/10.2174/1874325001711010051

    Article  PubMed  PubMed Central  Google Scholar 

  19. Christen B, Kopjar B (2018) Second-generation bi-cruciate stabilized total knee system has a lower reoperation and revision rate than its predecessor. Arch Orthop Trauma Surg 138:1591–1599. https://doi.org/10.1007/s00402-018-3019-5

    Article  PubMed  PubMed Central  Google Scholar 

  20. Harris AI, Christen B, Malcorps JJ et al (2019) Midterm performance of a guided-motion bicruciate-stabilized total knee system: results from the international study of over 2000 consecutive primary total knee arthroplasties. J Arthroplasty 34:S201–S208. https://doi.org/10.1016/j.arth.2019.02.011

    Article  PubMed  Google Scholar 

  21. Kim G-W, Jin QH, Lim J-H et al (2021) No difference of survival between cruciate retaining and substitution designs in high flexion total knee arthroplasty. Sci Rep 11:6537. https://doi.org/10.1038/s41598-021-85892-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Brown M, Ramasubbu R, Jenkinson M et al (2021) Significant differences in rates of aseptic loosening between two variations of a popular total knee arthroplasty design. Int Orthop 45:2859–2867. https://doi.org/10.1007/s00264-021-05151-w

    Article  PubMed  Google Scholar 

  23. Victor J, Mueller JKP, Komistek RD et al (2010) In vivo kinematics after a cruciate-substituting TKA. Clin Orthop Relat Res 468:807–814. https://doi.org/10.1007/s11999-009-1072-7

    Article  PubMed  Google Scholar 

  24. McCalden RW, Hart GP, MacDonald SJ et al (2017) Clinical results and survivorship of the GENESIS II total knee arthroplasty at a minimum of 15 years. J Arthroplasty 32:2161–2166. https://doi.org/10.1016/j.arth.2017.02.006

    Article  PubMed  Google Scholar 

  25. Ross Demcoe A, Bohm ER, Hedden DR et al (2019) Does oxidized zirconium make a difference? Midterm cohort survivorship of symmetric posterior condyle posterior-stabilized total knee arthroplasty. Can J Surg 62:118–122. https://doi.org/10.1503/cjs.007518

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mugnai R, Digennaro V, Ensini A et al (2014) Can TKA design affect the clinical outcome? Comparison between two guided-motion systems. Knee Surg Sports Traumatol Arthrosc 22:581–589. https://doi.org/10.1007/s00167-013-2509-9

    Article  PubMed  Google Scholar 

  27. Catani F, Ensini A, Belvedere C et al (2009) In vivo kinematics and kinetics of a bi-cruciate substituting total knee arthroplasty: a combined fluoroscopic and gait analysis study. J Orthop Res 27:1569–1575. https://doi.org/10.1002/jor.20941

    Article  PubMed  Google Scholar 

  28. Catani F, Innocenti B, Belvedere C et al (2010) The Mark Coventry Award articular: contact estimation in TKA using in vivo kinematics and finite element analysis. Clin Orthop Relat Res 468:19–28. https://doi.org/10.1007/s11999-009-0941-4

    Article  PubMed  Google Scholar 

  29. Arbuthnot JE, Brink RB (2009) Assessment of the antero-posterior and rotational stability of the anterior cruciate ligament analogue in a guided motion bi-cruciate stabilized total knee arthroplasty. J Med Eng Technol 33:610–615. https://doi.org/10.3109/03091900903067440

    Article  CAS  PubMed  Google Scholar 

  30. Kiyohara M, Hamai S, Gondo H et al (2021) Comparison of in vivo knee kinematics before and after bicruciate-stabilized total knee arthroplasty during squatting. BMC Musculoskelet Disord 22:772. https://doi.org/10.1186/s12891-021-04669-9

    Article  PubMed  PubMed Central  Google Scholar 

  31. Murakami K, Hamai S, Okazaki K et al (2018) In vivo kinematics of gait in posterior-stabilized and bicruciate-stabilized total knee arthroplasties using image-matching techniques. Int Orthop 42:2573–2581. https://doi.org/10.1007/s00264-018-3921-z

    Article  PubMed  Google Scholar 

  32. Ward TR, Burns AW, Gillespie MJ et al (2011) Bicruciate-stabilised total knee replacements produce more normal sagittal plane kinematics than posterior-stabilised designs. J Bone Joint Surg Ser B 93B:907–913. https://doi.org/10.1302/0301-620X.93B7.26208

    Article  Google Scholar 

  33. Yacovelli S, Grau LC, Hozack WJ, Courtney PM (2021) Functional Outcomes are comparable between posterior stabilized and cruciate-substituting total knee arthroplasty designs at short-term follow-up. J Arthroplasty 36:986–990. https://doi.org/10.1016/j.arth.2020.09.008

    Article  PubMed  Google Scholar 

  34. Laskin RS, Davis J (2005) Total knee replacement using the Genesis II prosthesis: a 5-year follow up study of the first 100 consecutive cases. Knee 12:163–167. https://doi.org/10.1016/j.knee.2004.07.006

    Article  PubMed  Google Scholar 

  35. Kahlenberg CA, Nwachukwu BU, McLawhorn AS et al (2018) Patient satisfaction after total knee replacement: a systematic review. HSS J 14:192–201. https://doi.org/10.1007/s11420-018-9614-8

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sahota S, Lovecchio F, Harold RE et al (2018) The effect of smoking on thirty-day postoperative complications after total joint arthroplasty: a propensity score-matched analysis. J Arthroplasty 33:30–35. https://doi.org/10.1016/j.arth.2017.07.037

    Article  PubMed  Google Scholar 

  37. Lim CT, Goodman SB, Huddleston JI et al (2017) Smoking is associated with earlier time to revision of total knee arthroplasty. Knee 24:1182–1186. https://doi.org/10.1016/j.knee.2017.05.014

    Article  PubMed  Google Scholar 

  38. He Y, Omar M, Feng X et al (2021) Impact of smoking on the incidence and postoperative complications of total knee arthroplasty: a systematic review and meta-analysis of cohort studies. Bosn J Basic Med Sci. https://doi.org/10.17305/bjbms.2021.6538

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA

    Ittai Shichman, Christian T. Oakley, Jeremiah Thomas, Ivan Fernandez-Madrid, Morteza Meftah & Ran Schwarzkopf

Authors
  1. Ittai Shichman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian T. Oakley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeremiah Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ivan Fernandez-Madrid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Morteza Meftah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ran Schwarzkopf
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Conceptualization was performed by RS and MM. Material preparation, data collection and analysis were performed by IS and JT. All statistical analysis was performed by Christian Oakley. Data validation was performed by IFD. The first draft of the manuscript was written by IS and CO Ittai and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ittai Shichman.

Ethics declarations

Conflict of interest

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. I.S, C.O, J.T, I.VM have nothing to disclose. M.M. reports being a paid consultant for Conformis and Intelijoint, have stock options from Caira surgical and Constance and received royalties from Innomed. Zimmer and R.S reports IP royalties from Smith & Nephew, being paid consultant for Smith & Nephew, Intelijoint, have stock options from Intelijoint, Gauss Surgical and receives research support from Smith & Nephew and Intelijoint.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shichman, I., Oakley, C.T., Thomas, J. et al. Comparison of traditional PS versus kinematically designs in primary total knee arthroplasty. Arch Orthop Trauma Surg 143, 5293–5301 (2023). https://doi.org/10.1007/s00402-023-04763-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-04763-8

Keywords

Search

Navigation