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No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial.
Knee Surg Sports Traumatol Arthrosc. 2017 Nov; 25(11):3515-3521.KS

Abstract

PURPOSE

The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior stabilized (PS) total knee arthroplasty (TKA). This study investigated range of motion (ROM), stability and patient-reported outcome (PRO) in UC and PS TKA. We hypothesized better knee flexion with the PS design but no difference in stability and PRO between UC and PS TKA.

METHODS

A randomized controlled study was performed. One hundred and twenty-seven patients were included, 63 with an UC and 64 with a PS TKA (Columbus, Aesculap, Tuttlingen, Germany). Intraoperative stability and range of motion was measured with the use of a navigation system. Patients were assessed before surgery, 3 months and 1 year postoperatively.

RESULTS

There was no difference in ROM between both groups, neither intraoperatively nor at follow-up. There was 5 mm less sagittal translation at 90° of knee flexion (p < 0.001) and more posterior femoral rollback during knee flexion in the PS TKA. Axial rotation between extension and knee flexion was reduced by both designs. UC TKA was 7 min faster (p = 0.001). At the one-year follow-up, the Knee Society Score was similar in both groups, the Oxford Knee Score demonstrated better results in the UC TKA group (p = 0.048).

CONCLUSION

Increased intraoperative sagittal translation and reduced posterior femoral rollback during knee flexion of UC TKA seem to have no negative influence on short-term clinical outcome. Therefore, UC TKA seems to be a practical alternative to the established PS TKA for substitution of the PCL. This might be especially interesting for surgeons who do not always substitute the PCL.

LEVEL OF EVIDENCE

I.

Authors+Show Affiliations

University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany. Joerg.Luetzner@uniklinikum-dresden.de.University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.Forum Gesundheit Dresden MVZ, Dresden, Germany.University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.St. Vincentus-Kliniken, Karlsruhe, Germany.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27659044

Citation

Lützner, Jörg, et al. "No Difference in Range of Motion Between Ultracongruent and Posterior Stabilized Design in Total Knee Arthroplasty: a Randomized Controlled Trial." Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, vol. 25, no. 11, 2017, pp. 3515-3521.
Lützner J, Beyer F, Dexel J, et al. No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3515-3521.
Lützner, J., Beyer, F., Dexel, J., Fritzsche, H., Lützner, C., & Kirschner, S. (2017). No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 25(11), 3515-3521. https://doi.org/10.1007/s00167-016-4331-7
Lützner J, et al. No Difference in Range of Motion Between Ultracongruent and Posterior Stabilized Design in Total Knee Arthroplasty: a Randomized Controlled Trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3515-3521. PubMed PMID: 27659044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. AU - Lützner,Jörg, AU - Beyer,Franziska, AU - Dexel,Julian, AU - Fritzsche,Hagen, AU - Lützner,Cornelia, AU - Kirschner,Stephan, Y1 - 2016/09/22/ PY - 2016/06/13/received PY - 2016/09/15/accepted PY - 2016/9/24/pubmed PY - 2018/4/12/medline PY - 2016/9/24/entrez KW - Deep dished insert KW - Range of motion KW - Results KW - Stability KW - TKA KW - TKR KW - Ultracongruent insert SP - 3515 EP - 3521 JF - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JO - Knee Surg Sports Traumatol Arthrosc VL - 25 IS - 11 N2 - PURPOSE: The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior stabilized (PS) total knee arthroplasty (TKA). This study investigated range of motion (ROM), stability and patient-reported outcome (PRO) in UC and PS TKA. We hypothesized better knee flexion with the PS design but no difference in stability and PRO between UC and PS TKA. METHODS: A randomized controlled study was performed. One hundred and twenty-seven patients were included, 63 with an UC and 64 with a PS TKA (Columbus, Aesculap, Tuttlingen, Germany). Intraoperative stability and range of motion was measured with the use of a navigation system. Patients were assessed before surgery, 3 months and 1 year postoperatively. RESULTS: There was no difference in ROM between both groups, neither intraoperatively nor at follow-up. There was 5 mm less sagittal translation at 90° of knee flexion (p < 0.001) and more posterior femoral rollback during knee flexion in the PS TKA. Axial rotation between extension and knee flexion was reduced by both designs. UC TKA was 7 min faster (p = 0.001). At the one-year follow-up, the Knee Society Score was similar in both groups, the Oxford Knee Score demonstrated better results in the UC TKA group (p = 0.048). CONCLUSION: Increased intraoperative sagittal translation and reduced posterior femoral rollback during knee flexion of UC TKA seem to have no negative influence on short-term clinical outcome. Therefore, UC TKA seems to be a practical alternative to the established PS TKA for substitution of the PCL. This might be especially interesting for surgeons who do not always substitute the PCL. LEVEL OF EVIDENCE: I. SN - 1433-7347 UR - https://www.unboundmedicine.com/medline/citation/27659044/No_difference_in_range_of_motion_between_ultracongruent_and_posterior_stabilized_design_in_total_knee_arthroplasty:_a_randomized_controlled_trial_ L2 - https://dx.doi.org/10.1007/s00167-016-4331-7 DB - PRIME DP - Unbound Medicine ER -