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Comparable level of joint awareness between the bi-cruciate and cruciate retaining total knee arthroplasty with patient-specific instruments: a case-controlled study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Bi-cruciate-retaining total knee arthroplasty (BCR-TKA) is recognized as an alternative to the cruciate-retaining total knee arthroplasty (CR-TKA) within the pursuit of retrieving the “forgotten artificial knee joint”. The aim of this study was to provide a short-term comparison in functional and clinical outcomes between BCR- and CR-TKA.

Methods

The cohort consisted of 61 BCR-TKA patients, matched with 61 suitable CR-TKA patients, and operated between 2014 and 2016 due to osteoarthritis. Patient-reported outcome measurements were assessed preoperatively and at 3, 12, 24 and 36 months postoperatively. In addition, perioperative conditions were observed and radiological images were analysed pre- and 1 year postoperatively. Effect size for the FJS-12 was calculated at 3-year follow-up to quantify the difference between BCR- and CR-TKA.

Results

Patients reported a significant improved health-related quality of life (p = 0.017) and a non-significant difference in joint awareness at 3-year-follow-up with a moderate effect size (0.4). Operating time in BCR-TKA (1:16, ± 0:16) is significantly longer (p < 0.000) than in CR-TKA (0:50, ± 0:12). Blood loss significantly increased (p = 0.005) in BCR-TKA (246.4 cc, 79.8) compared to CR-TKA (195.5 cc, ± 106.2). Comparable length of hospital stay (n.s.) was observed in BCR-TKA (1.1 days, ± 1.1) and CR-TKA (1.3 days, ± 1.3). Outliers of the hip–knee–ankle axis occurred significantly more frequent (P = 0.015) in the BCR group (37.7%) compared to CR-TKA (18.0%).

Conclusion

Joint awareness of the BCR-TKA was not significantly reduced compared to the CR-TKA. However, this study illustrates that bi-cruciate-retaining surgical technique for TKA is a promising step further in the pursuit of reducing joint awareness and retrieving the artificial forgotten total knee. Since a functional ACL increases rotational stability and proprioception, future research should focus on knee kinematics in modern BCR-TKA measured with gait analyses.

Level of evidence

IV therapeutic, retrospective, cohort study.

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Abbreviations

BCR-TKA:

Bi-Cruciate-retaining total knee arthroplasty

CR-TKA:

Cruciate-retaining total knee arthroplasty

ACL:

Anterior cruciate ligament

PCL:

Posterior cruciate ligament

PROMs:

Patient-reported outcome measures

FJS-12:

12-item Forgotten Joint Score

OKS:

Oxford Knee Score

WOMAC:

Western Ontario and McMaster Osteoarthritis

Q-5D:

The EuroQol

VAS:

Pain Visual Analogue Score

HKA:

Hip–knee–ankle angle

BMI:

Body Mass Index

KL score:

Kellgren–Lawrence Score

OA:

Osteoarthritis

ADL:

Activities of daily living

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Acknowledgements

We want to thank Dr Nanne Kort who operated all the patients.

Funding

For this study no funding has been received.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands

    Soufyan Kalaai, Marlon Scholtes, Bert Boonen, Emil van Haaren & Martijn Schotanus

  2. Department of Radiology, Zuyderland Medical Centre, Dr. H. van der Hoffplein, 1, 6162 BG, Sittard-Geleen, The Netherlands

    Rob Borghans

Authors
  1. Soufyan Kalaai
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  2. Marlon Scholtes
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  3. Rob Borghans
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  4. Bert Boonen
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  5. Emil van Haaren
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  6. Martijn Schotanus
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Contributions

SK conceived, designed, co-ordinated the study, collected and analysed the data and drafted the manuscript. MS collected the data. BB and EH critically reviewed the manuscript. MS participated in the design of the study, co-ordinated the study and critically reviewed the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Martijn Schotanus.

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Conflict of interest

Soufyan Kalaai, Marlon Scholtes, Bert Boonen, Emil van Haaren and Martijn Schotanus declare that they have no conflicts of interest.

Ethical approval

Ethical approval by the local ethical committee (email: METC@zuyderland.nl) was obtained for this study.

Informed consent

Informed consent was not necessary since it was a retrospective study.

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Kalaai, S., Scholtes, M., Borghans, R. et al. Comparable level of joint awareness between the bi-cruciate and cruciate retaining total knee arthroplasty with patient-specific instruments: a case-controlled study. Knee Surg Sports Traumatol Arthrosc 28, 1835–1841 (2020). https://doi.org/10.1007/s00167-019-05613-0

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  • DOI: https://doi.org/10.1007/s00167-019-05613-0

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