Posterior Cruciate-Retaining vs Posterior Cruciate-Stabilized Prosthesis in Total Knee Arthroplasty: A Meta-Analysis

Objective center dot To evaluate the clinical and imaging results of posterior cruciate-retaining vs the posterior cruciatestabilized method in total knee arthroplasty (TKA). Methods center dot PubMed, EMbase and Cochrane Library databases were used to retrieve randomized controlled trials (RCTs) concerning the posterior cruciate-retaining vs posterior cruciate-stabilized method in TKA. Determination of study quality and data extraction were performed by 2 reviewers. Study heterogeneity was assessed by ReviewManager (RevMan) software and metaanalysis was conducted. Results center dot A total of 15 RCTs were finally included in our meta-analysis. The results showed that no significant differences were found in the American Knee Society Score (AKSS) (MD = 0.13; 95% CI, -0.73 to 1.00), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MD= 0.59; 95% CI, 0.00-1.18), knee extension range of motion (MD = 0.10; 95% CI, -0.30 to 0.51)] or posterior tibial slope (MD = -0.09; 95% CI, -0.52-0.33) after surgery between the 2 groups. Compared with the posterior cruciate-retaining prosthesis group, in the posterior cruciate-stabilized prosthesis group the active knee joint range of motion was significantly increased (MD = -6.99; 95% CI, -9.17 to -4.81), knee flexion was significantly increased (MD = -4.22; 95% CI, -6.03 to -2.41) and the mechanical tibial angle was closed to 6 degrees (MD = 0.85; 95% CI, 0.46-1.25). There were no significant differences in residual knee pain (OR = 1.26; 95% CI, 0.572.78), infection rate at the surgical site (OR = 0.50, 95% CI, 0.13-1.88) or revision rate (OR = 0.59; 95% CI, 0.15-2.32) between the 2 groups. Funnel plot revealed no significant bias in the included studies. Conclusions center dot In summary, patients who received a posterior cruciate-stabilized prosthesis had better knee joint active range of motion, knee flexion and mechanical femorotibial angle than patients who received a posterior cruciate-retaining prosthesis. Due to the surgical difficulty involved in a posterior cruciate-retaining prosthesis, junior doctors should choose a posterior cruciatestabilized prosthesis first, and senior doctors should choose the prosthesis according to the patient's condition and the surgeon's proficiency at performing the surgery in question.