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Randomized Controlled Trial
. 2023 Dec;31(12):5856-5863.
doi: 10.1007/s00167-023-07634-2. Epub 2023 Nov 14.

PCL retained is safe in medial pivot TKA-a prospective randomized trial

Nicolaas C Budhiparama  1   2   3 , Imelda Lumban-Gaol  4 , Kiki Novito  4 , Hendy Hidayat  4 , Federico De Meo  5 , Giorgio Cacciola  5 , Pietro Cavaliere  5
Affiliations
Randomized Controlled Trial

PCL retained is safe in medial pivot TKA-a prospective randomized trial

Nicolaas C Budhiparama et al. Knee Surg Sports Traumatol Arthrosc. 2023 Dec.

Abstract

Purpose: Medial pivot (MP) designs resemble native knee kinematics and restore the "natural" kinematics of a knee after total knee arthroplasty (TKA). However, whether to preserve or resect the posterior cruciate ligament (PCL) is still under debate. We inquired whether sacrificing the PCL would improve range of motion, functional outcomes, and limb alignment compared to preserving the PCL in TKA using medial pivot implants (MP-TKA).

Methods: This prospective, double-blinded, randomized controlled trial consisted of 33 patients (66 knees) undergoing bilateral simultaneous MP-TKA. In one knee, a PCL preservation technique was performed, and in the contralateral knee, the PCL was resected. The primary outcome was postoperative range of motion (ROM). The secondary outcomes were visual analogue scale (VAS) score for knee pain at walking, Knee Injury and Osteoarthritis Outcome Score for symptoms (KOOS-S) and quality of life (KOOS-QoL), Oxford knee score (OKS), and Forgotten Joint Score (FJS), and measurement of the mechanical femoral-tibial axis (mFTA) on X-ray images. All patients were followed up for a minimum of 2 years after surgery.

Results: Patients who underwent MP-TKA with PCL preservation had a similar ROM at 2 years (125.45 ± 7.00 vs. 126.21 ± 6.73, p = 0.65) as those who underwent MP-TKAs with PCL resection. There was also no difference in VAS score (1.94 ± 0.79 vs. 2.00 ± 0.71, respectively, p = 0.51), OKS (39.97 ± 2.01 vs. 39.67 ± 2.03, respectively, p = 0.52), KOOS-S (84.41 ± 3.77 vs. 84.19 ± 3.57, respectively, p = 0.92), KOOS-QoL (82.94 ± 4.76 vs. 82.75 ± 4.70, respectively, p = 0.84), or FJS (72.66 ± 8.99 vs. 72.35 ± 8.64, respectively, p = 0.76) at the 2-year follow-up. No difference in the measurement of the mFTA was found between the two groups (180.27 ± 2.25 vs. 181.30 ± 2.13, respectively, p = 0.59).

Conclusion: This study demonstrated that both medial pivot TKA with PCL preservation and PCL resection achieved excellent results. There was no difference at the 2-year follow-up in terms of postoperative ROM, patient-reported outcomes, or radiographic evaluation.

Level of evidence: Therapeutic study, Level I.

Keywords: Medial pivot TKA; Medial pivot prosthesis; PCL; PCL resection; PCL retention; PCL sacrifice.

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Conflict of interest statement

GC, HH, ILG, and KN declare no conflict of interest. FDM and PC are part of the speakers bureau for Gruppo Bioimpianti. PC receives a royalty from Gruppo Bioimpianti. NCB receives payment and benefit from DePuy Johnson and Johnson and Zimmer Biomet, and sits on the editorial board of CORR, BJJ, OJSM, JISAKOS, and KSSR.

Figures

Fig. 1
Fig. 1
CONSORT flowchart
See this image and copyright information in PMC

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