Primary total knee replacement using dished polyethylene with resected posterior cruciate ligament
Keywords:Total knee replacement, Dished poly insert, Midterm results
Background: The choice between preserving, sacrificing or substituting the posterior cruciate ligament (PCL) is always a controversial topic in total knee replacement (TKR). Dished polyethylene insert with PCL resection enables correction of the commonly present fixed flexion and varus deformities. Additionally, the risk of premature wear of polyethylene is less because of the confirming articular geometry between the femoral and tibial component.
Methods: This is a retrospective study in which we studied 120 knees in 95 consecutive patients undergoing primary TKR by the senior author at our institute. We used TKR system with dished metal backed polyethylene tibial component. PCL resection was performed in all cases. Pre-operative and post-operative functional assessment were done using knee society clinical scores and Western Ontario and McMaster universities osteoarthritis index (WOMAC). All radiographs were assessed using the knee society Roentgenographic scoring system (KSRES). Statistical analysis was performed using paired student t tests. Survivorship was determined using Kaplan-Meier survivorship curves.
Results: Mean follow-up was 8 years. Range of motion increased from 75 degrees to 110 degrees. The knee society pain score increased from 30 to 94. The knee society function score increased from 35 to 75. WOMAC score increased in terms of pain, stiffness and physical function.
Conclusions: We conclude that deep dish bearing is a viable option in presence of deficient PCL and provides adequate stability and functional outcome. We need a larger sample size, multicentre trial and longer follow-up to see for complication rate, revision rate and survival.
Dorr LD, Ochsner JL, Gronley J. Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee Arthroplasty, Clin Orthop. 1988;36.
Hirsch HS, Lotke PA, Morrison LD. The posterior cruciate ligament in total knee surgery. Save, sacrifice, or substitute? Clin Orthop. 1994;64.
Dennis DA, Komistek RD, Stiehl JB. Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty. 1998;13:748.
Soudry M, Walker PS, Reilly DT. Effects of total knee replacement design on femoral-tibial contact conditions. J Arthroplasty. 1986;1:35.
Laskin RS, Maruyama Y, Villaneuva M. Deep dish congruent tibial component use in total knee arthroplasty: a randomized prospective study. Clin Orthop. 2000;36.
Scott RD, Thornhill TS. Posterior cruciate supplementing total knee replacement using conforming inserts and cruciate recession. Effect on range of motion and radiolucent lines. Clin Orthop. 1994;146.
Font-Rodriquez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop. 1997;79.
Sathappan SS, Bradley W, William LJ. Midterm results of primary total knee arthroplasty using a dished polyethylene insert with recessed or resected posterior cruciate ligament. J Arthroplasty. 2006;21:1012.
Bartel DL, Rawlinson JJ, Burstein AH. Stresses in polyethylene components of contemporary total knee replacements. Clin Orthop. 1995;76.
Parsley BS, Conditt MA, Bertolusso R, Noble PC. Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty. 2006;21(6-2):127-31.
Serna-Berna R, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Navarro B, Lopez-Prats FA. Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison with a Minimum Follow-Up of 10 Years. J Arthroplasty. 2018;33(8):2491-5.