Cruciate Retaining Versus Cruciate Stabilising Total Knee Arthroplasty – A Prospective Randomised Kinematic Study

Abstract

Objective: While there is a large body of research in regards to cruciate retaining(CR) and cruciate sacrificing total condylar knee replacement, the literature is spars in regards to highly conforming polyetheylene such as the triatholon cruciate stabilising tibial insert (CS).The aim was to determine whether there is a difference in the range of motion, kinematics as well as the functional outcome for Triathlon CS and CR TKJR. Methods: A single hospital consecutive series of one surgeon between 2011 and 2013 were enrolled. Kinematic data recorded prospectively at the time of surgery utilizing imageless navigation included preoperative and postreplacement extension, gravity flexion, passive flexion and rotation. Intraoperative femoral and tibial cuts and definitive implants were also recorded. Statistically analysis performed to compare CS and CR TKJR range of motion, deformity correction, and rotation pre and post‐operatively.. Oxford functional scores were obtained at the final follow up. 124 patients were randomised to 71 CS and 53 CR TKJR. The demographics were comparable between the two groups. Results: No significant difference was found between the groups' preoperative range of motion. The net gain in extension for the CS group was 5.65 degrees (4.14‐7.17) and for CR 5.64 degrees (4.24‐7.04, p=0.99) with no significant difference shown. Post‐operative gravity flexion significantly increased in CS TKJR with 129.01 degrees (127.37130.66) compared with 126.35 degrees (124.39‐128.30, p =0.04) for CR. A weak positive correlation was shown between the size of distal femoral cut and post‐operative extension for both CS and CR TKJR. A weak positive correlation was also shown for the difference between the intraoperative cuts (tibial and femoral) and the size of the implants used, in relation to post‐operative extension. Post‐operative oxford scores at average of 3.4 year follow up comparable between groups. Conclusion: The kinematics of CS and CR TKJR are comparable. The post‐operative gravity flexion achieved with CS TKJR was statistically greater than for CR TKJR. Patients perceptions at an average 3.4 year follow up were comparable.