Primary total knee replacement using dished polyethylene with resected posterior cruciate ligament

Mohan M. Kumar, Satvik N. Pai, Pravin K. Vanchi, Raghav Ravi, Syam Nath


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.


Total knee replacement, Dished poly insert, Midterm results

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