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Meta-Analysis
. 2016 Jan 29;11(1):e0147865.
doi: 10.1371/journal.pone.0147865. eCollection 2016.

Posterior Cruciate Ligament Retention versus Posterior Stabilization for Total Knee Arthroplasty: A Meta-Analysis

Chao Jiang  1 , Zhenlei Liu  1 , Ying Wang  2 , Yanyan Bian  1 , Bin Feng  1 , Xisheng Weng  1
Affiliations
Meta-Analysis

Posterior Cruciate Ligament Retention versus Posterior Stabilization for Total Knee Arthroplasty: A Meta-Analysis

Chao Jiang et al. PLoS One. .

Abstract

Introduction: Although being debated for many years, the superiority of posterior cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior-stabilized (PS) TKA remains controversial. We compare the knee scores, post-operative knee range of motion (ROM), radiological outcomes about knee kinematic and complications between CR TKA and PS TKA.

Methods: Literature published up to August 2015 was searched in PubMed, Embase and Cochrane databases, and meta-analysis was performed using the software, Review Manager version 5.3.

Results: Totally 14 random control trials (RCTs) on this topic were included for the analysis, which showed that PS and CR TKA had no significant difference in Knee Society knee Score (KSS), pain score (KSPS), Hospital for Special Surgery score (HSS), kinematic characteristics including postoperative component alignment, tibial posterior slope and joint line, and complication rate. However, PS TKA is superior to CR TKA regarding post-operative knee range of motion (ROM) [Random Effect model (RE), Mean Difference (MD) = -7.07, 95% Confidential Interval (CI) -10.50 to -3.65, p<0.0001], improvement of ROM (Fixed Effect model (FE), MD = -5.66, 95% CI -10.79 to -0.53, p = 0.03) and femoral-tibial angle [FE, MD = 0.85, 95% CI 0.46 to 1.25, p<0.0001].

Conclusions: There are no clinically relevant differences between CR and PS TKA in terms of clinical, functional, radiological outcome, and complications, while PS TKA is superior to CR TKA in respects of ROM, while whether this superiority matters or not in clinical practice still needs further investigation and longer follow-up.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study selection.
Fig 2
Fig 2. Quality assessment summary.
Grey with a minus sign: High risk; Yellow with a question mark: Unclear risk; Green with a plus sign: Low risk. Graded according to the instruction in RevMan software.
Fig 3
Fig 3. Funnel plot for publication bias inspection.
All included studies are within the dotted line, indicating no significant publication bias among the studies.
Fig 4
Fig 4. Meta-analysis of the clinical scores (Panel A-E).
A. Meta-analysis of Knee Society knee Score (KSS). B. Meta-analysis of Knee Society function score (KSFS). C. Meta-analysis of Knee Society pain score (KSPS). D. Meta-analysis of Hospital for Special Surgery score (HSS). E. Meta-analysis of Western Ontario and McMaster Universities score (WOMAC). CR, Posterior Cruciate-retaining prostheses. PS, Posterior-Stabilized prostheses. Fixed, Fixed Effect model. Random, Random Effect model. SD, Standard Deviation. CI, Confidence Interval.
Fig 5
Fig 5. Meta-analysis of clinical function (Panel A-D).
A. Meta-analysis of post-operative knee Range of Motion (ROM). B. Meta-analysis of knee flexion. C. Meta-analysis of knee extension. D. Meta-analysis of improvement of ROM.
Fig 6
Fig 6. Meta-analysis of kinematic characteristics (Panel A-E).
A. Meta-analysis of tibial component alignment. B. Meta-analysis of femoral component alignment. C. Meta-analysis of tibial posterior slope. D. Meta-analysis of joint line. E. Meta-analysis of femoral-tibial angle.
Fig 7
Fig 7. Meta-analysis of complications.
See this image and copyright information in PMC

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