García-Estrada Edgar Iván, Ramírez-Yañez Emmanuel, Álvarez-Alarcón Gilberto, Muñoz-Nieto David, Villaseñor-Valdés José Juan, Núñez-García Luis Antonio
Orthopedic Surgery, Hospital de Especialidades Instituto Mexicano del Seguro Social (IMSS) Bienestar, Tampico, MEX.
Orthopedic Surgery, Hospital General de Zona of Instituto Mexicano del Seguro Social (IMSS) 7, Monclova, MEX.
Cureus. 2025 Jul 7;17(7):e87465. doi: 10.7759/cureus.87465. eCollection 2025 Jul.
Introduction Total knee arthroplasty (TKA) is the definitive surgical treatment for advanced gonarthrosis when conservative measures fail. Among the available implant designs, posterior cruciate-retaining (PCR) and posterior-stabilized (PS) prostheses are widely used, yet their comparative performance in long-term functional recovery and health-related quality of life remains under debate. Methods We conducted a prospective observational study involving 48 elderly patients undergoing primary TKA at a tertiary-care center in Mexico. Participants received either PCR (n=27) or PS (n=21) implants based on intraoperative assessment. Patient-reported outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the 36-Item Short Form Health Survey (SF-36), and Patient-Reported Outcomes Measurement Information System (PROMIS-10) Global Health questionnaire at preoperative, six, 12, and 24 months postoperatively. Results Both groups demonstrated improvements in all outcome measures; however, PCR patients consistently achieved better results across the follow-up period. At 24 months, WOMAC scores, which reflect better symptom control with higher values, were superior in the PCR group for pain (77.5 vs. 71.0), stiffness (72.5 vs. 62.5), and physical function (86.5 vs. 82.6). SF-36 also favored PCR in physical functioning (66.5 vs. 64.1), bodily pain (72.1 vs. 70.0), and role-physical (54.0 vs. 51.0). PROMIS-10 confirmed these trends, with higher physical (73.9 vs. 71.3) and mental health scores (75.2 vs. 72.0) among PCR patients at 24 months. Conclusions Patients receiving cruciate-retaining prostheses experienced greater and more sustained improvements in pain relief, joint function, and quality of life compared to those with posterior-stabilized implants. These findings support the functional advantage of PCR designs in elderly patients undergoing TKA and highlight the value of long-term, multidimensional outcome assessment using patient-reported outcome measures (PROMs).
引言
全膝关节置换术（TKA）是晚期膝关节炎保守治疗无效时的确定性手术治疗方法。在现有的植入物设计中，后交叉韧带保留型（PCR）和后稳定型（PS）假体被广泛使用，但其在长期功能恢复和健康相关生活质量方面的比较性能仍存在争议。
方法
我们在墨西哥的一家三级医疗中心进行了一项前瞻性观察研究，纳入了48例接受初次TKA的老年患者。根据术中评估，参与者接受了PCR（n = 27）或PS（n = 21）植入物。使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、36项简短健康调查问卷（SF - 36）以及患者报告结局测量信息系统（PROMIS - 10）全球健康问卷，在术前、术后6个月、12个月和24个月评估患者报告的结局。
结果
两组在所有结局指标上均有改善；然而，在整个随访期间，PCR组患者始终取得更好的结果。在24个月时，反映症状控制较好且分数越高越好的WOMAC评分在PCR组中，疼痛方面（77.5对71.0）、僵硬方面（72.5对62.5）和身体功能方面（86.5对82.6）均更优。SF - 36在身体功能（66.5对64.1）、身体疼痛（72.1对70.0）和角色 - 身体（54.0对51.0）方面也更倾向于PCR组。PROMIS - 10证实了这些趋势，在24个月时，PCR组患者的身体（73.9对71.3）和心理健康评分（75.2对72.0）更高。
结论
与后稳定型植入物患者相比，接受交叉韧带保留型假体的患者在疼痛缓解、关节功能和生活质量方面有更大且更持久的改善。这些发现支持了PCR设计在接受TKA的老年患者中的功能优势，并强调了使用患者报告结局测量（PROMs）进行长期、多维度结局评估的价值。
