Comparison of Functional Outcomes Between the First and Second Knee in Staged Bilateral Total Knee Arthroplasty With Diverse Intervals Between Stages

Background: The objective of the study was to analyze if the length of interval time between stages influenced functional and quality of life outcomes in patients with staged bilateral primary total knee arthroplasty (TKA). Methods: This is a retrospective comparative study between 93 patients with an interval between stages of 6-8 months (6-month group), 112 of 12-14 months (1-year group), and 108 of 24-26 months (2-year group). Outcome variables were Knee Society scores, Western Ontario and McMaster Universities, Short Form, and patient satisfaction. Results: Overall, the mean follow-up for the first TKA was 8.2 (range, 7-10) years, and for the second TKA, 6.7 (range, 5-10) years. At last follow-up, functional and patient-related outcomes were similar for both knees, regardless of the interval. However, mental score and patient satisfaction were significantly better for the second than for the first TKA in the 2-year group. Age did not correlate significantly with the functional scores but was significantly correlated with the mental score. Conclusion: The performing staged bilateral TKA with a wide interval between surgeries provided equivalent functional outcomes and quality of life for both knees. Postoperative outcomes were not affected by the length of the time interval between procedures or age. Our results can help the surgeon to inform the patients reliably about what they can expect in the delay of a second knee replaced. Thus, patients could make an informed decision

Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison With a Minimum Follow-Up of 10 Years

Background: Controversy continues regarding whether the posterior cruciate ligament should be retained or removed during total knee arthroplasty (TKA) procedure. The objective was to compare the clinical outcomes with a minimum follow-up of 10 years between patients who received contemporary cruciate-retaining or posterior-stabilized primary TKA. Methods: Case-control study of 268 patients who underwent cruciate-retaining TKA vs 211 to posterior-stabilized design, with the same arthroplasty system, and a minimum follow-up of 10 years. Clinical assessment was performed by Knee Society scores, Western Ontario and MacMasters Universities and Short-Form 12 questionnaires, range of motion, and patient satisfaction. Results: Successful outcomes were found for both designs. No significant differences in functional scores, range of motion, patient-related scores, or patient satisfaction. Between the 5-year and last postoperative follow-up, there were a significant decrease of all clinical scores in both groups. In addition, complication rate and implant survival were similar between groups. Conclusion: The superiority of one design over the other was not found. Both designs can be used expecting long-term successful outcomes and high survival. The choice of the design depended on the status of the posterior cruciate ligament and surgeon preference

Prótesis de rodilla. Análisis del beneficio clínico entre la conservación o resección del ligamento cruzado posterior

Antecedentes: La artroplastia total de rodilla es una de las intervenciones más eficientes y consolidadas en el campo de la cirugía ortopédica para el tratamiento de la artrosis de rodilla avanzada, cuando fracasan las medidas terapéuticas no quirúrgicas. En la actualidad, continúa la controversia con respecto a si el ligamento cruzado posterior debe mantenerse o resecarse durante el procedimiento quirúrgico. Objetivo: El objetivo de nuestro estudio, fue comparar los resultados clínicos con un seguimiento mínimo de 10 años entre los pacientes que fueron tratados con artroplastia primaria de rodilla con retención del ligamento cruzado posterior y los que fueron tratados con una artroplastia primaria de rodilla estabilizada posterior tras resección del ligamento cruzado posterior. Material y Métodos: Estudio de casos y controles de 268 pacientes que se sometieron a una artroplastia primaria de rodilla con retención del ligamento cruzado posterior, versus 211 pacientes con diseño estabilizado posterior, con el mismo sistema de artroplastia excepto en el mecanismo de poste-leva y con un seguimiento mínimo de 10 años. La evaluación clínica se realizó mediante la escala Knee Society System, el cuestionario Western Ontario y MacMasters Universities y Short-Form 12 , el rango de movilidad de la rodilla y grado de satisfacción del paciente. Resultados: Con ambos diseños protésicos, obtuvimos resultados clínicos exitosos sin encontrar diferencias significativas en las puntuaciones funcionales globales, del rango de movilidad y en las puntuaciones relacionadas con el paciente o su satisfacción. Además, la tasa de complicaciones y la supervivencia del implante fueron similares en ambos grupos. Conclusiones: En artrosis de rodilla con integridad del ligamento cruzado posterior, tanto la artroplastia primaria con retención del ligamento cruzado posterior como la artroplastia primaria postero-estabilizada, proporciona buenos resultados clínicos a 5 y 10 años, no encontrando la superioridad de un diseño sobre el otro. Ambos modelos protésicos se pueden usar esperando resultados satisfactorios a largo plazo y una alta supervivencia del implante