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General Orthopaedics

Comparison of Stability and Outcome of PCL Substituting and PCL Sacrificing TKA (A Randomized Controlled Trial)

International Society for Technology in Arthroplasty (ISTA) 2012 Annual Congress



Abstract

Introduction

The purpose of this study was to determine whether the patient's perceived outcome and speed of recovery differs between a posterior cruciate ligament (PCL) substituting (cam-post type) and PCL sacrificing (ultracongruent polyethylene) total knee arthroplasty (TKA).

Methods

Thirty eight patients (mean age, 65 years) underwent bilateral TKA using a PCL substituting and a PCL sacrificing prosthesis on each side. At each follow-up, the stability of anteroposterior and mediolateral laxity using stress radiographs, range of motion, quadriceps muscle power recovery using isokinetic dynamometer and radiographs were evaluated. At the 1-year evaluation, we asked, “Which is your better knee overall?” to determine the patients' preferences.

Results

The mean varus/valgus laxities were 1.6Ë�/3.9Ë� in the PCL sacrificing side and 2.3Ë�/5.9Ë� in the PCL substituting side, and the mean anterior/posterior laxities were 6.4 mm/14.2 mm and 3.0 mm/7.3 mm at the 1-year follow up, respectively. Isokinetic peak torque at 60°/sec and 180°/sec in extension was 130% and 113% compared to the preoperative value in the PCL sacrificing side and 109% and 110% in the PCL substituting side, respectively. The differences in the posterior laxity and isokinetic peak torque at 60°/sec were significant statistically. Sixty-one percent preferred PCL sacrificing side to PCL substituting side.

Conclusion

PCL sacrificing TKA showed more posterior laxity and better quadriceps muscle power at the time of short-term follow-up. Patients with bilateral TKA preferred PCL sacrificing TKA to PCL substituting TKA. Longer follow-up is needed to determine whether there will be an advantage in terms of longer-term function.