Bi-cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes
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Bi-cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes. / Boese, Christoph Kolja; Ebohon, Stephen; Ries, Christian; De Faoite, Diarmuid.
In: ARCH ORTHOP TRAUM SU, Vol. 141, No. 2, 02.2021, p. 293-304.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Bi-cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes
AU - Boese, Christoph Kolja
AU - Ebohon, Stephen
AU - Ries, Christian
AU - De Faoite, Diarmuid
PY - 2021/2
Y1 - 2021/2
N2 - Total knee arthroplasty (TKA) has been shown to have good long-term outcomes and survivorship. Nonetheless, dissatisfied patients are frequently reported in the literature. Bi-cruciate retaining total knee prostheses (BCR TKA) were designed to address the demand for more kinematically functional implants that better reconstruct natural knee kinematics. In BCR TKA, the anterior cruciate ligament (ACL) is preserved. Improved patient-reported outcomes and satisfaction levels are expected. This review aimed to summarize indications for and clinical outcomes of BCR TKA. A systematic literature review on BCR TKA was performed. 24 articles were included for data analysis. Indications covered osteoarthritis, inflammatory arthritis and others. The degree of deformity was often but not always limited to minor axial deformity and contractures: maximum acceptable varus/valgus deformity reached 10°-30° and flexion contractures of 15°-65°. ACL intactness was macroscopically examined intraoperatively in nine studies and clinically tested in ten studies (e.g., Lachmann Test, drawer-test). Objective and patient-reported outcome scores were reported for follow-up periods of up to 22 years. Survival rates varied significantly. For first generation implants, 22-year survival reached 82% while a second generation design was associated with 13.5% revision rate at 18 months. Reasons for varying outcomes were not clear and may be attributed to the implant itself, surgical techniques and patient specific variables including changed expectations and functional demand. The literature has not shown clear indications and guidelines for the use of BCR implants. The promising results of first generation BCR TKA designs may be optimized through improved implant designs in the future. Further studies are advocated to provide the necessary evidence of second generation BCR TKA designs.
AB - Total knee arthroplasty (TKA) has been shown to have good long-term outcomes and survivorship. Nonetheless, dissatisfied patients are frequently reported in the literature. Bi-cruciate retaining total knee prostheses (BCR TKA) were designed to address the demand for more kinematically functional implants that better reconstruct natural knee kinematics. In BCR TKA, the anterior cruciate ligament (ACL) is preserved. Improved patient-reported outcomes and satisfaction levels are expected. This review aimed to summarize indications for and clinical outcomes of BCR TKA. A systematic literature review on BCR TKA was performed. 24 articles were included for data analysis. Indications covered osteoarthritis, inflammatory arthritis and others. The degree of deformity was often but not always limited to minor axial deformity and contractures: maximum acceptable varus/valgus deformity reached 10°-30° and flexion contractures of 15°-65°. ACL intactness was macroscopically examined intraoperatively in nine studies and clinically tested in ten studies (e.g., Lachmann Test, drawer-test). Objective and patient-reported outcome scores were reported for follow-up periods of up to 22 years. Survival rates varied significantly. For first generation implants, 22-year survival reached 82% while a second generation design was associated with 13.5% revision rate at 18 months. Reasons for varying outcomes were not clear and may be attributed to the implant itself, surgical techniques and patient specific variables including changed expectations and functional demand. The literature has not shown clear indications and guidelines for the use of BCR implants. The promising results of first generation BCR TKA designs may be optimized through improved implant designs in the future. Further studies are advocated to provide the necessary evidence of second generation BCR TKA designs.
KW - Arthroplasty, Replacement, Knee/adverse effects
KW - Biomechanical Phenomena
KW - Humans
KW - Knee/surgery
KW - Patient Reported Outcome Measures
KW - Treatment Outcome
U2 - 10.1007/s00402-020-03622-0
DO - 10.1007/s00402-020-03622-0
M3 - SCORING: Review article
C2 - 33047230
VL - 141
SP - 293
EP - 304
JO - ARCH ORTHOP TRAUM SU
JF - ARCH ORTHOP TRAUM SU
SN - 0936-8051
IS - 2
ER -