Favorable outcomes of posterior cruciate-stabilized inserts over ultracongruent inserts in total knee arthroplasty

ObjectivePosterior cruciate-stabilized (PS) and ultracongruent (UC) inserts are used during total knee arthroplasty (TKA), but superiority in gaining postoperative knee flexion and functionality remains contested. Therefore, this study compared postoperative outcomes between PS and UC inserts.MethodsA retrospective review evaluated unilateral or bilateral TKAs with PS or UC inserts from August 2011 to March 2020. Nonparametric statistics were performed to evaluate differences in patient demographics, pre- and postknee flexion and Knee Society Knee (KSS-K) and Function Score (KSS-F). Univariate and multivariable regressions were performed to evaluate the influence on postoperative knee flexion >= 120 degrees, presented as odds ratios (OR) and 95% confidence intervals (CI).ResultsPatient demographics were not significantly different between the 577 PS and 399 UC knees evaluated. Postoperatively, a larger proportion of UC knees demonstrated knee flexion < 120 degrees (36.0% vs. 18.6%, p < 0.001) and lower KSS-K (91.0 +/- 8.7 vs. 91.6 +/- 10.3, p < 0.001) and KSS-F (76.8 +/- 21.6 vs. 79.9 +/- 21.6, p = 0.007) than the PS group. The PS group had greater improvement in flexion angle (4.9 degrees +/- 14.9 degrees vs. 1.0 degrees +/- 15.6 degrees, p < 0.001) and KSS-F (27.3 +/- 23.3 vs. 23.1 +/- 25.3, p = 0.007) as compared to that of UC patients. Patients with preoperative flexion < 120 degrees (OR 2.787, CI 2.066-3.761; p < 0.001), higher body mass index (OR 1.033, CI 1.006-1.061; p = 0.017) and UC insert (OR 2.461, CI 1.832-3.307; p < 0.001) were less likely to achieve flexion >= 120 degrees.ConclusionFavorable clinical and functional outcomes were noted in the PS group as compared to UC inserts in TKA. The greater improvement in overall knee flexion may suggest the PS insert may be especially appropriate for patients with lower preoperative range of motion.