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Scientific Articles   |    
Increased Long-Term Survival of Posterior Cruciate-Retaining Versus Posterior Cruciate-Stabilizing Total Knee Replacements
Matthew P. Abdel, MD; Mark E. Morrey, MD; Matthew R. Jensen, BS; Bernard F. Morrey, MD
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Department of Orthopedic Surgery (M.P.A., M.E.M., and B.F.M.) and Division of Biostatistics (M.R.J.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for B.F. Morrey: morrey.bernard@mayo.edu
Investigation performed at the Department of Orthopedic Surgery and Division of Biostatistics, Mayo Clinic, Rochester, Minnesota
A commentary by Gerard A. Engh, MD, is linked to the online version of this article at jbjs.org.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Nov 16;93(22):2072-2078. doi: 10.2106/JBJS.J.01143
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Abstract

Background: 

Considerable debate remains regarding the use of posterior cruciate-retaining or posterior cruciate-stabilizing designs for total knee arthroplasty. Multiple studies have investigated kinematic, radiographic, and clinical outcomes of both. Nevertheless, long-term survivorship analyses directly comparing the two designs have not been performed, to our knowledge. Our goal was to analyze the fifteen-year survival of posterior cruciate-retaining and posterior cruciate-stabilizing total knee replacements at our institution.

Methods: 

A retrospective review identified 8117 total knee arthroplasties (5389 posterior cruciate-retaining and 2728 posterior cruciate-stabilizing) that had been performed from 1988 to 1998. This range was chosen because both designs were used in high volumes at our institution during this period. Patients were followed via our total joint registry at one, two, and five years after the arthroplasty and every five years thereafter. Aseptic revision surgery was the primary end point of our analysis. Implant survival was estimated with Kaplan-Meier curves.

Results: 

Survival at fifteen years was 90% for posterior cruciate-retaining total knee replacements, compared with 77% for posterior cruciate-stabilizing total knee replacements (p < 0.001). In knees with preoperative deformity, the fifteen-year survival was 90% for posterior cruciate-retaining total knee replacements, compared with 75% for posterior cruciate-stabilizing total knee replacements (p < 0.04). Likewise, in knees without preoperative deformity, the fifteen-year survival was 88% for posterior cruciate-retaining total knee replacements, compared with 78% for posterior cruciate-stabilizing total knee replacements (p < 0.001). After adjustment for age, sex, preoperative diagnosis, and preoperative deformity, the risk of revision was significantly lower in knees with a posterior cruciate-retaining total knee replacement (p < 0.001; hazard ratio = 0.5; 95% confidence interval, 0.4 to 0.6).

Conclusions: 

In evaluating the implants used at our institution for total knee arthroplasty during the study period, posterior cruciate-retaining prostheses had significantly improved survival in comparison with posterior cruciate-stabilizing prostheses at fifteen years. Furthermore, this significant difference remained when accounting for age, sex, diagnosis, and deformity.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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