Clin Orthop Surg.  2019 Jun;11(2):142-150. 10.4055/cios.2019.11.2.142.

What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty

• Song SJ
• Park CH
• Bae DK

• KMID: 2445047
• DOI: http://doi.org/10.4055/cios.2019.11.2.142

Abstract

There has been continuing debate about the superiority of cruciate-retaining (CR) total knee arthroplasty (TKA) versus posterior-stabilized (PS) TKA for obtaining knee joint stability with functional improvement. Many surgeons tend to select the type of prosthesis on the basis of their own training and experience. However, the selection must be based on a great store of knowledge rather than on the surgeon's preconceptions or preferences. CR TKA may not be feasible in certain settings: posterior cruciate ligament insufficiency, severe deformity, and history of trauma or surgery. The risk of conversion from a CR type prosthesis to a PS type prosthesis might be high in patients with severe flexion contracture, steep posterior slope, and small femoral component size. The above factors should be carefully considered for an appropriate selection of the type of prosthesis. The surgeon should have a clear understanding on the technical differences between CR and PS TKAs. The amount of distal femoral resection, femoral component size, and tibial slope are particularly crucial for successful TKA. Unless they are meticulously determined, stiffness or instability will ensue, which can be difficult to resolve afterwards. There was no notable difference in functional outcome, range of motion, kinematics, and survival rate between CR and PS TKAs in most previous studies. Strict adherence to surgical indications and solid understanding of differences in surgical principles might be more important than the selection of either a CR or PS prosthesis.

Keyword

Knee; Arthroplasty; Cruciate retaining; Posterior stabilized

Figure

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  Fig. 1 Postoperative radiographs showing insufficiency due to progressive weakening of the posterior cruciate ligament (PCL) tension. (A) One-year postoperative (right knee) and 14-year postoperative (left knee) radiographs after cruciate-retaining total knee arthroplasty (CR TKA); the sagittal angle of the CR TKA was 0.9° of flexion. (B) Three-year postoperative (right knee) and 17-year postoperative (left knee) radiographs after CR TKA. Gradual insufficiency of the PCL tension caused hyperextension of the left knee although she had no clinical instability symptoms and limited range of motion; the sagittal angle was 10.5° of hyperextension.

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  Fig. 2 Reciprocating sawing performed in front of the posterior cruciate ligament (PCL) insertion site. It helps to estimate the passage of the saw during tibial resection and preserve the bone island of the PCL insertion site.

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  Fig. 3 Posterior cruciate ligament (PCL) recession at the tibial insertion of the PCL during cruciate-retaining total knee arthroplasty for gradual decrease of the PCL tension and gradual increase of the flexion gap.

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