Mid-flexion stability in the anteroposterior plane is achieved with a medial congruent insert in cruciate-retaining total knee arthroplasty for varus osteoarthritis

Abstract

Purpose: This study aimed to compare the intraoperative kinematics, especially for mid-flexion femorotibial anteroposterior (AP) stability, between newly developed medial congruent (MC) inserts and cruciate-retaining (CR) inserts in navigated cruciate-retaining total knee arthroplasty (CR-TKA).

Methods: Thirty consecutive patients with varus osteoarthritis undergoing CR-TKA using an image-free navigation system were enrolled. AP kinematics, the AP translation under manual maximum stress to the knee joint at 45° flexion, rotational kinematics, and varus-valgus laxity were evaluated using a navigation system and statistically compared between the MC and CR inserts.

Results: AP kinematic analysis showed that the femoral position with the CR insert was significantly anterior at a maximum extension to 45° flexion compared with the MC insert (p < 0.05). The amount of AP translation at 45° flexion with the MC insert was significantly smaller than that with the CR insert (p < 0.05). Rotational kinematics found that the tibial position at maximum extension was significantly externally rotated with the MC inserts than with the CR inserts. Varus-valgus laxity was comparable between the MC and CR inserts.

Conclusion: The current results showed that greater mid-flexion AP stability was achieved with the MC inserts than with the CR inserts in CR-TKA. Intraoperative kinematics with the MC inserts more closely resembled those with preoperative conditions in CR-TKA.

Level of evidence: III, prospective comparative study.

Keywords: Cruciate-retaining total knee arthroplasty; Intraoperative kinematics; Medial congruent insert; Mid-flexion stability; Paradoxical motion.