University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany.
University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany; Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
J Arthroplasty. 2024 Feb;39(2):368-373. doi: 10.1016/j.arth.2023.08.044. Epub 2023 Aug 19.
Both the cruciate-retaining (CR) and posterior-stabilized (PS) implant systems are commonplace in modern total knee arthroplasty (TKA) practice. However, there is controversy regarding functional outcomes and survivorship. The aim of the underlying study was to evaluate differences between CR and PS TKA regarding knee function, patient-reported outcome measures (PROMs) as well as complication rates.
140 patients with knee osteoarthritis scheduled for an unconstrained TKA were enrolled in a prospective, randomized study. Patients received either a CR or PS implant. Range of motion and PROMs (Oxford Knee Score, Knee Society Score, European Quality of Life 5 Dimensions 3 Level, University of California Los Angeles Activity scale and subjective satisfaction) were assessed prior to, 3 months, 1 and 2 years after surgery.
We found minor differences between treatment groups regarding demographic factors. Within the PS group duration of surgery was longer (mean PS 81.4 min vs CR 76.0 min, P = .006). We observed better flexion (median PS 120.0° vs CR 115°, P = .017) and an overall better range of motion (median PS 120.0° vs CR 115.0°, P = .008) for the PS group. PROMs did not differ between groups. At 2-year follow-up there were no revisions in either cohort. Five patients needed reoperations. Three patients needed manipulation under anesthesia, 2 in the CR and one in the PS group.
While PS TKA achieved a better flexion capability, PROMs were similar in CR and PS TKA. The CR implant design continues to be a reliable option for patients with an intact posterior cruciate ligament.
在现代全膝关节置换术（TKA）实践中，交叉韧带保留（CR）和后稳定（PS）植入系统都很常见。然而，关于功能结果和生存率仍存在争议。本研究旨在评估 CR 和 PS TKA 在膝关节功能、患者报告的结果测量（PROM）以及并发症发生率方面的差异。
140 例膝关节骨关节炎患者接受非约束性 TKA ，前瞻性、随机研究。患者接受 CR 或 PS 植入物。在手术前、手术后 3 个月、1 年和 2 年，评估关节活动度和 PROM（牛津膝关节评分、膝关节协会评分、欧洲生活质量 5 维度 3 水平、加州大学洛杉矶活动量表和主观满意度）。
我们发现治疗组之间在人口统计学因素方面存在微小差异。在 PS 组中，手术时间较长（PS 组平均 81.4 分钟，CR 组 76.0 分钟，P=0.006）。我们观察到 PS 组的屈曲角度更好（PS 组中位数 120.0°，CR 组中位数 115.0°，P=0.017），整体活动范围更好（PS 组中位数 120.0°，CR 组中位数 115.0°，P=0.008）。两组的 PROM 无差异。在 2 年随访时，两组均无翻修。五例患者需要再次手术。3 例需要在全身麻醉下进行手法复位，CR 组 2 例，PS 组 1 例。
虽然 PS TKA 达到了更好的屈曲能力，但 CR 和 PS TKA 的 PROM 相似。对于后交叉韧带完整的患者，CR 植入物设计仍然是一种可靠的选择。
