A study of clinical and functional outcome of primary total knee arthroplasty using posterior cruciate substitute design


  • Radhakrishna A. M. Department of Orthopaedics, Kempegowda Institute of Medical Science and Research Centre, Bengaluru, India
  • Shivananda S. Department of Orthopaedics, Kempegowda Institute of Medical Science and Research Centre, Bengaluru, India
  • Girish S. Department of Orthopaedics, Kempegowda Institute of Medical Science and Research Centre, Bengaluru, India




Clinical and functional outcome, Knee society score, Total knee replacement, Posterior substitute design


Background: To study the clinical and functional outcome in a consecutive series of Total Knee Arthroplasty using Posterior cruciate substituting (PS) design using the Knee Society Score(KSS). The objectives of the study was 1) To assess the improvement in pain relief post-operatively, stability, mobility of the joint and to assess the correction of deformities. 2) To compare the knee clinical score (KCS) pre-operatively and post-operatively. 3) To compare the knee functional score (KFS) pre-operatively and post-operatively. 4) To assess the radiological outcome of total knee arthroplasty. 5) To study the association between the KCS and the KFS.

Methods: The study was conducted on patients who have undergone Primary total knee replacement, in Department of Orthopaedics, KIMS hospital from June 2014 to February 2017. The patient was assessed clinically, functionally using the Knee Society Score and a radiographic evaluation was done. These evaluations were performed at 6weeks, 12 weeks, 24 weeks and 1year follow up visits.

Results: At 1 year follow up of 60 knees, the average pre-op knee clinical score and functional score of 24.7 and 41.2 improved to an average post-op score of 89.9 and 87.8 respectively. Knee clinical and functional score grade of excellent to good was seen in 96.7% (58 knees of 60). Significant association was seen between KCS and KFS. 5 patients had delayed wound healing and one patient had deep infection. Alignment of prosthesis was found satisfactory in all patients. Flexion deformity, valgus and varus correction achieved in all the patients.

Conclusions: Total knee arthroplasty using posterior cruciate substituting designs resulted in excellent relief of pain, range of motion, restoration of function, low prevalence of patellofemoral complications and continues to function well during the follow-up period. Improvement in clinical score correlated significantly with improvement in functional score. Knee society scoring system effective in evaluating clinical, functional and radiological outcomes.


Author Biography

Radhakrishna A. M., Department of Orthopaedics, Kempegowda Institute of Medical Science and Research Centre, Bengaluru, India

junior resident

department of orthopaedics


Vail TP, Lang JE. Insall and Scott surgery of the knee. 4th ed. Philadelphia: Churchill Livingstone, Elsevier; 2006: 1455-1521.

Insall J, Ranawat CS, Scott WN, Walker P. Total condylar knee replacement. Preliminary report. Clin Orthop Relat Res. 1976;120:149-54.

Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 201;377:2115-26.

Lachiewicz, Paul F. Cement versus Cementless Total Knee Replacement: Is There a Place for Cementless Fixation in 2001? Curr Opinion Orthop. 2001;12(1):33-6.

Rand, JA, Ilstrup DM. Survivorship Analysis of Total Knee Arthroplasty. Cumulative Rates of Survival of 9200 Total Knee Arthroplasties. J Bone Joint Surg Am. 1991;73(1):397-409.

Ranawat CS, Luessenhop CP Rodriguez JA. The press-fit condylar modular total knee system: Four to six year results with a posterior-cruciate-substituting design. J Bone Joint Surg. 1997;79:342–8.

Insall J, Lachiewicz P, Burstein A. The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two to four year clinical experience. J Bone Joint Surg. 1982;64:1317–23.

Insall J, Ranawat C, Aglietti P, Shine J. A comparison of four models of total knee replacement prostheses. J Bone Joint Surg. 1976;58:754–65.

Ranawat C, Flynn W, Saddler S, Hansraj K, Maynard M. Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop. 1993;286:96–102.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of The Knee Society Clinical Rating System. Clin Orthop. 1989;248:13-4.

Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;(248):9-12.

Dowsey MM, Nikpour M, Dieppe P, Choong PF. Associations between Pre-operative Radiographic Changes and Outcomes after Total Knee Joint Replacement for Osteoarthritis. Osteoarthritis Cartilage. 2012;20(10):1095-102.

Hunter N, Clayton RAE, Brenkel IJ. Press Fit Condylar Sigma Total Knee Arthroplasty: 7 -9 Years Results, Eur J Orthop Surg & Traumatol. 2009;19(6):409-13.

Zaki SH, Rafiq I, Kapoor A, Videsh R, Gambhir AK, Porter ML, et al. Medium Term Results with the Press Fit Condylar (PFC) Sigma Knee Proisthesis the Wrightington Experience. Acta Orthopaedica Belgica. 2007;73(1):55-9.

Aglietti P, Buzzi R. Posteriorly stabilized total-condylar knee replacement. three to eight years follow-up of 85 knees. J Bone Joint Surg. 1988;70:211–6.

Ritter MA, Davis KE, Farris A, Keating EM, Faris PM. The Surgeon's Role in Relative Success of PCL-Retaining and PCL-Substituting Total Knee Arthroplasty. HSS J. 2014;10(2):107-15.

Tomek IM, Kantor SR, Cori LA, Scoville JM, Grove MR, Morgan TS, et al. Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques: A Randomized, Double-Blind Clinical Trial. J Bone Joint Surg Am. 2014;96(11):907-15.

Smith AJ, Lloyd DG, Wood DJ. A kinematic analysis of walking after total knee arthroplasty with and without patellar resurfacing. Clin Biochem. 2006;21:379–86.

Laskin, Richard S. Total Knee Arthroplasty Using an Uncemented, Polyethylene Tibial Implant A Seven-Year Follow-Up Study. Clinical Orthopaedics and Related Research 1993;288:270.

Laskin, Richard S. The Genesis Total Knee Prosthesis. Clin Orthop Relat Res. 2001;388:95-102.

Sancheti KH, Laud NS, Bhende H, Reddy G, Pramod N, Mani JN. The INDUS Knee Prosthesis - Prospective Multicentric Trial of a Posteriorly Stabilized High-flex Design: 2 Years Follow-up. Indian J Orthop. 2009;43(4):367-74.

Scott WN1, Rubinstein M, Scuderi G. Results after Knee Replacement with a Posterior Cruciate-substituting Prosthesis. J Bone Joint Surg Am. 1988;70(8):1163-73.

Scott S, Norman W, Rubinstein M. Posterior Stabilized Knee Arthroplasty. Clin Orthop Relat Res. l986;205:38-45.

Stern SH, Insall JN. Posterior stabilized prostheses. Results after follow-up of nine to twelve years. J Bone Joint Surg. 1992;74:980–6.

Colizza W, Insall JN, Scuderi GR. The posterior stabilized knee prosthesis. Assessment of polyethylene damage and osteolysis after a minimum ten-year follow-up. J Bone Joint Surg 1995;77:1713–20.

Carl D, Greenbaum G, Stern J, Braffman M, Paul A, et al. Open Debridement of Acute Gram-Positive Infections After Total Knee Arthroplasty. Clin Orthop Relat Res. 2003;416:129-34.

Mont, Michael A, Waldman B, Banerjee C, Pacheco IH, Hungerford DS, et al. Multiple Irrigation, Debridement, and Retention of Components in Infected Total Knee Arthroplasty. J Arthroplasty. 1997;12(4):426-33.

Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect. 1999;48:111.

Salvati EA, Robinson RP, Zeno SM. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg. 1982;64:525.

Wilson MG, Kelley K, Thornhill TS. Infection as a complication of total knee- replacement arthroplasty. J Bone Joint Surg. 1990;72:878.






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