232. TOTAL KNEE ARTHROPLASTY WITH PRESERVATION OF THE POSTERIOR CRUCIATE LIGAMENT: 10 YEARS FOLLOW-UP

Abstract

Purpose of the study: Total knee arthroplasty (TKA) is considered to be an effective treatment for degenerative knee joint disease when the functional impairment and the pain fail to respond to medical treatment. The success of TKA is determined by the degree of pain relief, functional recovery, and implant survival. For many years, those advocating or not preservation of the posterior cruciate ligament (PCL) have animated lively debates. Although a consensus has not been reached, posterior stabilised prostheses and prostheses with a mobile plateau are commonly implanted. The purpose of our study was to compare the outcomes obtained with fixed plateau TKA with preservation of the PCL with those obtained with other prostheses with or without sacrifice of the PCL with a fixed or mobile plateau.

Material and methods: This was a prospective study in a single centre including a homogenous consecutive series of 12 TKA (cemented EUROP) with a fixed plateau and preservation of the PCL implanted from 1994 to 1996 in 117 patients aged 73 years on average. The International Knee Society scores were used for the clinical and radiographic assessment at ten years.

Results: At ten years follow-up, 23 patients had died, 14 were lost to follow-up and 80 (82 knees) were evaluated clinically and 43 (45 knees) radiographically. The IKS knee score varied from 31 points (0–60) preoperatively to 88 points (30–98) postoperatively at last follow-up. The IKS function score was 40 points (0–90) preoperatively and 80 (25–100) at last follow-up. Lucent lines were noted for 59% of the condyles and 60% of the tibial plateaus. The lucencies were mainly located in the anterior and posterior zones of the femur (zones 1 and 4) and medially on the tibia (zones 1 and2). Two prostheses were revised at 8 and 11 years for loosening. The overall survival was 98.8% at ten years using the Kaplan-Meier method.

Discussion: The clinical and radiological outcomes of prostheses with fixed plateaus and preserving the PCL in our series with one revision at 10 years were very satisfactory. Our results are comparable with earlier reports in the literature with or without sacrifice of the PCL with a fixed or mobile plateau.

Conclusion: Longer term follow-up will be needed to confirm these results beyond ten years.