Abstract
Purpose
In the present study, knee joint kinematics (e.g. knee flexion/extension) and kinetics (e.g. knee flexion moments) are assessed after total knee arthroplasty (TKA) between patients implanted with either a unilateral posterior stabilized (PS) and a posterior cruciate-retaining (PCR) design. It was hypothesized that maximum knee flexion during the loading response of the stance phase is greater in patients implanted with a PS design than in patients with a PCR design. Secondarily, it was hypothesized that patients with a PS design show decreased knee flexion moments during loading, compared with patients implanted with a PCR design.
Methods
This study examined two groups of TKA patients: one group (n = 12) with a PS design in which the posterior cruciate ligament (PCL) was sacrificed and the other (n = 9) with a PCR design. Gait analysis was used in level walking before and 6–9 months after surgery, to assess knee joint kinematics and kinetics during the loading response of the stance phase.
Results
No significant differences in maximum knee flexion between the two groups were found during the loading response of the stance phase. No significant differences in knee flexion moments were found either. Although in both groups knee flexion moments increased postoperatively, this was not statistically significant. In the contralateral (nonimplanted) knees, all mean knee flexion moments decreased postoperatively for both groups, yet this was not significant.
Conclusions
The present gait analysis study showed no differences in kinematics and kinetics between the PS and the PCR TKP design. This might suggest that surgeons do not necessarily need to substitute the PCL by a PS design during TKA.
Level of evidence
Prospective comparative study, Level II.
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References
Andriacchi TP, Galante JO, Fermier RW (1982) The influence of total knee-replacement design on walking and stair climbing. J Bone Joint Surg Am 64(9):1328–1335
Bellamy N (1982) Osteoarthritis. An evaluative index for clinical trials. MSc thesis, McMaster University, Hamilton, ON, Canada
Bolanos AA, Colizza WA, McCann PD, Gotlin RS, Wootten ME, Kahn BA, Insall JN (1998) A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties. J Arthroplasty 13:906–915
Davis RB, Ounpuu S, Tyburski D, Gage JR (1991) A gait analysis data collection and reduction technique. Hum Mov Sci 5:575–587
Dennis DA, Komistek RD, Hoff WA, Gabriel SM (1996) In vivo knee kinematics derived using an inverse perspective technique. Clin Orthop Relat Res 331:107–117
Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57
Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB (2003) Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res 416:37–57
Dorr LD, Ochsner JL, Gronley J, Perry J (1988) Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty. Clin Orthop Relat Res 236:36–43
Ferrari A, Benedetti MG, Pavan E, Frigo C, Bettinelli D, Rabuffetti M, Crenna P, Leardini A (2008) Quantitative comparison of five current protocols in gait analysis. Gait Posture 28(2):207–216
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
Joglekar S, Gioe TJ, Yoon P, Schwartz MH (2012) Gait analysis comparison of cruciate retaining and substituting TKA following PCL sacrifice. Knee 19(4):279–285
Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8(3):383–392
Li N, Tan Y, Deng Y, Cheng L (2014) Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 22(3):556–564
Lombardi AV Jr, Mallory TH, Fada RA, Hartman JF, Capps SG, Kefauver CA, Adams JB (2001) An algorithm for the posterior cruciate ligament in total knee arthroplasty. Clin Orthop Relat Res 392:75–87
McClelland JA, Webster KE, Feller JA (2007) Gait analysis of patients following total knee replacement: a systematic review. Knee 14(4):253–263
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
Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res 356:39–46
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(7):940–945
Parsley BS, Conditt MA, Bertolusso R, Noble PC (2006) Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 21(6):127–131
Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, Willems WJ, Heyligers IC, Voaklander DC, Kelly KD, Suarez-Almazor ME (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63(1):36–42
Seon JK, Park JK, Shin YJ, Seo HY, Lee KB, Song EK (2011) Comparisons of kinematics and range of motion in high-flexion total knee arthroplasty: cruciate retaining vs. substituting designs. Knee Surg Sports Traumatol Arthrosc 19(12):2016–2022
Straw R, Kulkarni S, Attfield S, Wilton TJ (2003) Posterior cruciate ligament at total knee replacement. Essential, beneficial or a hindrance? J Bone Joint Surg Br 85(5):671–674
Van den Boom LG, Brouwer RW, van den Akker-Scheek I, Bulstra SK, van Raaij JJ (2009) Retention of the posterior cruciate ligament versus the posterior stabilized design in total knee arthroplasty: a prospective randomized controlled clinical trial. BMC Musculoskelet Disord 30(10):119
Verra WC, van den Boom LG, Jacobs W, Clement DJ, Wymenga AA, Nelissen RG (2013) Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev 11(10):CD004803
Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and—substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br 87:646–655
Winter DA (1984) Biomechanics of human movement with applications to the study of human locomotion. Crit Rev Biomed Eng 9(4):287–314
Acknowledgments
The authors would like to thank all the patients for their contribution. The randomized controlled trial from which the patients in this manuscript were recruited was supported by Biomet.
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van den Boom, L.G.H., Halbertsma, J.P.K., van Raaij, J.J.A.M. et al. No difference in gait between posterior cruciate retention and the posterior stabilized design after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22, 3135–3141 (2014). https://doi.org/10.1007/s00167-014-3215-y
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DOI: https://doi.org/10.1007/s00167-014-3215-y