High-flexion posterior-substituting versus cruciate-retaining prosthesis in total knee arthroplasty: functional outcome, range of motion and complication comparison

Currently, a high-flexion cruciate-retaining knee prosthesis has been designed to allow greater advantage after total knee arthroplasty (TKA). The present study was conducted to compare functional outcome, range of motion (ROM) as well as complications in subjects who underwent either a high-flexion cruciate-retaining (HFCR, Group I) or a high-flexion posterior-substituting (HFPS, Group II) prosthesis TKA.

Thirty-four subjects which had TKA with HFCR prosthesis and thirty-three subjects which had TKA with HFPS prosthesis were enrolled in our study and were assessed preoperatively and at 24 months postoperatively. For functional outcome comparison, Hospital for Special Surgery Score (HSSS), Knee Society Score (KSS, including the Mean Knee Score and the Mean Function Score) as well as SF12 Score (including Mental Health Score and Physical Health Score) were measured. For ROM comparison, the arcs of maximal non-weight-bearing passive flexion and weight-bearing flexion were detected, and the number of knees which allowed patients to kneel and sit cross-legged in comfort was determined. For complication comparison, wound necrosis/discharge, anterior knee pain, dislocation, radiolucent lines as well as osteolysis were investigated.

At 24-month follow-up, no significant difference in functional outcome between the two groups was detected. The average maximal non-weight-bearing flexion was 136.2° for the knees in Group I and 135.1° for the knees in Group II (P > 0.05). The average weight-bearing flexion was 123.2° for the knees in Group I and 129.8° for the knees in Group II (P > 0.05). No significant difference, with regard to the number of knees that allowed kneeling and sitting cross-legged, was detected. Comparisons of postoperative complications between the two groups did not yield a significant difference.

Our study demonstrated no advantage of the high-flexion cruciate- retaining TKA over high-flexion posterior-substituting TKA with regard to functional outcome, range of motion as well as complications at short-term follow-up. However, longer follow-up is necessary to confirm whether these results are sustained.