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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2023

Open Access 12-09-2022 | KNEE

Medial pivot-based total knee arthroplasty achieves better clinical outcomes than posterior-stabilised total knee arthroplasty

Authors: Michitaka Kato, Hideki Warashina, Shingo Mitamura, Akito Kataoka

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

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Abstract

Purpose

Stability in the sagittal plane, particularly regarding anterior cruciate ligament compensation, and postoperative functionality and satisfaction remain issues in total knee arthroplasty. Therefore, this prospective study compared the clinical outcomes between medial-pivot-based and posterior-stabilised total knee arthroplasty based on anterior translation and clinical scores.

Methods

To assess outcomes of total knee arthroplasty for varus osteoarthritis, the anterior translation distance of the tibia relative to the femur was measured at 30 and 60° of flexion using a KS measure Arthrometer at 6 months postoperatively. The 2011 Knee Society Score, Forgotten Joint Score, visual analogue scale for pain, and range of motion were assessed at 6 months and 1 year postoperatively. The correlations among each score, anterior translation distance, range of motion, and visual analogue scale score for pain were investigated.

Results

The medial-pivot and posterior-stabilised groups comprised 70 and 51 patients, respectively. The medial-pivot group exhibited a significantly shorter anterior translation distance at 60° flexion than the posterior-stabilised group. Furthermore, the medial-pivot group achieved significantly better outcomes regarding the visual analogue scale for pain, 2011 Knee Society Score, and Forgotten Joint Score than the posterior-stabilised group. A significant negative correlation was observed between the anterior translation distance and the function score of the 2011 Knee Society Score, whereas a significant positive correlation was found between the anterior translation distance and flexion angle, and between the extension angle and score of the Forgotten Joint Score or 2011 Knee Society Score. Significant negative correlations were also found between the pain visual analogue scale and both the 2011 Knee Society Score and Forgotten Joint Score.

Conclusion

In total knee arthroplasty for osteoarthritis, the medial-pivot group displayed a shorter anterior translation distance than the posterior-stabilised group at 6 months postoperatively. The visual analogue scale score for pain was also significantly lower in the medial-pivot group than that in the posterior-stabilised group at both 6 months and 1 year postoperatively. Because a correlation was observed between the anterior translation distance and the function score, medial-pivot-based total knee arthroplasty was considered to significantly improve postoperative function compared to posterior-stabilised total knee arthroplasty.
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Literature
1.
go back to reference Abdelnasser MK, Elsherif ME, Bakr H, Mahran M, Othman MHM, Khalifa Y (2019) All types of component malrotation affect the early patient-reported outcome measures after total knee arthroplasty. Knee Surg Relat Res 31(1):5CrossRefPubMedPubMedCentral Abdelnasser MK, Elsherif ME, Bakr H, Mahran M, Othman MHM, Khalifa Y (2019) All types of component malrotation affect the early patient-reported outcome measures after total knee arthroplasty. Knee Surg Relat Res 31(1):5CrossRefPubMedPubMedCentral
2.
go back to reference Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176CrossRef Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176CrossRef
3.
go back to reference Bae DK, Cho SD, Im SK, Song SJ (2016) Comparison of midterm clinical and radiographic results between total knee arthroplasties using medial pivot and posterior-stabilized prosthesis-a matched pair analysis. J Arthroplast 31(2):419–424CrossRef Bae DK, Cho SD, Im SK, Song SJ (2016) Comparison of midterm clinical and radiographic results between total knee arthroplasties using medial pivot and posterior-stabilized prosthesis-a matched pair analysis. J Arthroplast 31(2):419–424CrossRef
4.
go back to reference Batra S, Malhotra R, Kumar V, Srivastava DN, Backstein D, Pandit H (2021) Superior patient satisfaction in medial pivot as compared to posterior-stabilized total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 29(11):3633–3640CrossRefPubMed Batra S, Malhotra R, Kumar V, Srivastava DN, Backstein D, Pandit H (2021) Superior patient satisfaction in medial pivot as compared to posterior-stabilized total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 29(11):3633–3640CrossRefPubMed
5.
go back to reference Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplast 27(3):430-436.e1CrossRef Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplast 27(3):430-436.e1CrossRef
6.
go back to reference Benjamin B, Pietrzak JRT, Tahmassebi J, Haddad FS (2018) A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait. Bone Jt J 100-B(1 supple A):76–82CrossRef Benjamin B, Pietrzak JRT, Tahmassebi J, Haddad FS (2018) A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait. Bone Jt J 100-B(1 supple A):76–82CrossRef
7.
go back to reference Bordini B, Ancarani C, Fitch DA (2016) Long-term survivorship of a medial-pivot total knee system compared with other cemented designs in an arthroplasty registry. J Orthop Surg Res 11:44CrossRefPubMedPubMedCentral Bordini B, Ancarani C, Fitch DA (2016) Long-term survivorship of a medial-pivot total knee system compared with other cemented designs in an arthroplasty registry. J Orthop Surg Res 11:44CrossRefPubMedPubMedCentral
8.
go back to reference Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63CrossRefPubMed Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63CrossRefPubMed
9.
go back to reference Cacciola G, Mancino F, De Meo F, Di Matteo V, Sculco PK, Cavaliere P et al (2021) Mid-term survivorship and clinical outcomes of the medial stabilized systems in primary total knee arthroplasty: a systematic review. J Orthop 24:157–164CrossRefPubMedPubMedCentral Cacciola G, Mancino F, De Meo F, Di Matteo V, Sculco PK, Cavaliere P et al (2021) Mid-term survivorship and clinical outcomes of the medial stabilized systems in primary total knee arthroplasty: a systematic review. J Orthop 24:157–164CrossRefPubMedPubMedCentral
10.
go back to reference Choi WC, Ryu KJ, Lee S, Seong SC, Lee MC (2013) Painful patellar clunk or crepitation of contemporary knee prostheses. Clin Orthop Relat Res 471(5):1512–1522CrossRefPubMed Choi WC, Ryu KJ, Lee S, Seong SC, Lee MC (2013) Painful patellar clunk or crepitation of contemporary knee prostheses. Clin Orthop Relat Res 471(5):1512–1522CrossRefPubMed
11.
go back to reference Dowsey MM, Gould DJ, Spelman T, Pandy MG, Choong PF (2020) A randomized controlled trial comparing a medial stabilized total knee prosthesis to a cruciate retaining and posterior-stabilized design: a report of the clinical and functional outcomes following total knee replacement. J Arthroplast 35(6):1583-1590.e2CrossRef Dowsey MM, Gould DJ, Spelman T, Pandy MG, Choong PF (2020) A randomized controlled trial comparing a medial stabilized total knee prosthesis to a cruciate retaining and posterior-stabilized design: a report of the clinical and functional outcomes following total knee replacement. J Arthroplast 35(6):1583-1590.e2CrossRef
12.
go back to reference Edelstein AI, Bhatt S, Wright-Chisem J, Sullivan R, Beal M, Manning DW (2020) The effect of implant design on sagittal plane stability: a randomized trial of medial- versus posterior-stabilized total knee arthroplasty. J Knee Surg 33(5):452–458CrossRefPubMed Edelstein AI, Bhatt S, Wright-Chisem J, Sullivan R, Beal M, Manning DW (2020) The effect of implant design on sagittal plane stability: a randomized trial of medial- versus posterior-stabilized total knee arthroplasty. J Knee Surg 33(5):452–458CrossRefPubMed
13.
go back to reference Gray HA, Guan S, Young TJ, Dowsey MM, Choong PF, Pandy MG (2020) Comparison of posterior-stabilized, cruciate-retaining, and medial-stabilized knee implant motion during gait. J Orthop Res 38(8):1753–1768CrossRefPubMed Gray HA, Guan S, Young TJ, Dowsey MM, Choong PF, Pandy MG (2020) Comparison of posterior-stabilized, cruciate-retaining, and medial-stabilized knee implant motion during gait. J Orthop Res 38(8):1753–1768CrossRefPubMed
14.
go back to reference Ingelsrud LH, Roos EM, Terluin B, Gromov K, Husted H, Troelsen A (2018) Minimal important change values for the Oxford Knee Score and the Forgotten Joint Score at 1 year after total knee replacement. Acta Orthop 89(5):541–547CrossRefPubMedPubMedCentral Ingelsrud LH, Roos EM, Terluin B, Gromov K, Husted H, Troelsen A (2018) Minimal important change values for the Oxford Knee Score and the Forgotten Joint Score at 1 year after total knee replacement. Acta Orthop 89(5):541–547CrossRefPubMedPubMedCentral
15.
go back to reference Ishii Y, Matsuda Y, Ishii R, Sakata S, Omori G (2005) Sagittal laxity in vivo after total knee arthroplasty. Arch Orthop Trauma Surg 125(4):249–253CrossRefPubMed Ishii Y, Matsuda Y, Ishii R, Sakata S, Omori G (2005) Sagittal laxity in vivo after total knee arthroplasty. Arch Orthop Trauma Surg 125(4):249–253CrossRefPubMed
16.
go back to reference Jacobs CA, Christensen CP, Karthikeyan T (2016) An intact anterior cruciate ligament at the time of posterior cruciate ligament-retaining total knee arthroplasty was associated with reduced patient satisfaction and inferior pain and stair function. J Arthroplast 31(8):1732–1735CrossRef Jacobs CA, Christensen CP, Karthikeyan T (2016) An intact anterior cruciate ligament at the time of posterior cruciate ligament-retaining total knee arthroplasty was associated with reduced patient satisfaction and inferior pain and stair function. J Arthroplast 31(8):1732–1735CrossRef
17.
go back to reference Jones CW, Jacobs H, Shumborski S, Talbot S, Redgment A, Brighton R et al (2020) Sagittal stability and implant design affect patient reported outcomes after total knee arthroplasty. J Arthroplast 35(3):747–751CrossRef Jones CW, Jacobs H, Shumborski S, Talbot S, Redgment A, Brighton R et al (2020) Sagittal stability and implant design affect patient reported outcomes after total knee arthroplasty. J Arthroplast 35(3):747–751CrossRef
18.
go back to reference Kim YH, Park JW, Kim JS (2017) Clinical outcome of medial pivot compared with press-fit condylar sigma cruciate-retaining mobile-bearing total knee arthroplasty. J Arthroplast 32(10):3016–3023CrossRef Kim YH, Park JW, Kim JS (2017) Clinical outcome of medial pivot compared with press-fit condylar sigma cruciate-retaining mobile-bearing total knee arthroplasty. J Arthroplast 32(10):3016–3023CrossRef
19.
go back to reference Kim YH, Yoon SH, Kim JS (2009) Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis. Clin Orthop Relat Res 467(2):493–503CrossRefPubMed Kim YH, Yoon SH, Kim JS (2009) Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis. Clin Orthop Relat Res 467(2):493–503CrossRefPubMed
20.
go back to reference Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed
21.
go back to reference Lee QJ, Wai Yee EC, Wong YC (2020) No difference in patient preference for medial pivot versus posterior-stabilized design in staged bilateral total knee arthroplasty: a prospective study. Knee Surg Sports Traumatol Arthrosc 28(12):3805–3809CrossRefPubMed Lee QJ, Wai Yee EC, Wong YC (2020) No difference in patient preference for medial pivot versus posterior-stabilized design in staged bilateral total knee arthroplasty: a prospective study. Knee Surg Sports Traumatol Arthrosc 28(12):3805–3809CrossRefPubMed
22.
go back to reference Lin Y, Chen X, Li L, Li Z, Zhang Y, Fan P (2020) Comparison of patient satisfaction between medial pivot prostheses and posterior-stabilized prostheses in total knee arthroplasty. Orthop Surg 12(3):836–842CrossRefPubMedPubMedCentral Lin Y, Chen X, Li L, Li Z, Zhang Y, Fan P (2020) Comparison of patient satisfaction between medial pivot prostheses and posterior-stabilized prostheses in total knee arthroplasty. Orthop Surg 12(3):836–842CrossRefPubMedPubMedCentral
23.
go back to reference Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 471(1):127–133CrossRefPubMed Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 471(1):127–133CrossRefPubMed
24.
go back to reference Matsumoto K, Ogawa H, Yoshioka H, Akiyama H (2017) Postoperative anteroposterior laxity influences subjective outcome after total knee arthroplasty. J Arthroplast 32(6):1845–1849CrossRef Matsumoto K, Ogawa H, Yoshioka H, Akiyama H (2017) Postoperative anteroposterior laxity influences subjective outcome after total knee arthroplasty. J Arthroplast 32(6):1845–1849CrossRef
25.
go back to reference Matsumoto M, Baba T, Homma Y, Kobayashi H, Ochi H, Yuasa T et al (2015) Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure. Eur J Orthop Surg Traumatol 25(7):1141–1145CrossRefPubMed Matsumoto M, Baba T, Homma Y, Kobayashi H, Ochi H, Yuasa T et al (2015) Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure. Eur J Orthop Surg Traumatol 25(7):1141–1145CrossRefPubMed
26.
go back to reference Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Nakamura H (2016) Mobile-bearing TKA improved the anteroposterior joint stability in mid-flexion range comparing to fixed-bearing TKA. Arch Orthop Trauma Surg 136(11):1601–1606CrossRefPubMed Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Nakamura H (2016) Mobile-bearing TKA improved the anteroposterior joint stability in mid-flexion range comparing to fixed-bearing TKA. Arch Orthop Trauma Surg 136(11):1601–1606CrossRefPubMed
27.
go back to reference Nishitani K, Yamamoto Y, Furu M, Kuriyama S, Nakamura S, Ito H et al (2019) The minimum clinically important difference for the Japanese version of the new Knee Society Score (2011KSS) after total knee arthroplasty. J Orthop Sci 24(6):1053–1057CrossRefPubMed Nishitani K, Yamamoto Y, Furu M, Kuriyama S, Nakamura S, Ito H et al (2019) The minimum clinically important difference for the Japanese version of the new Knee Society Score (2011KSS) after total knee arthroplasty. J Orthop Sci 24(6):1053–1057CrossRefPubMed
28.
go back to reference O’Connor MI (2011) Implant survival, knee function, and pain relief after TKA: are there differences between men and women? Clin Orthop Relat Res 469(7):1846–1851CrossRefPubMedPubMedCentral O’Connor MI (2011) Implant survival, knee function, and pain relief after TKA: are there differences between men and women? Clin Orthop Relat Res 469(7):1846–1851CrossRefPubMedPubMedCentral
29.
go back to reference Øhrn FD, Gøthesen Ø, Låstad Lygre SH, Peng Y, Lian ØB, Lewis PL et al (2020) Decreased survival of medial pivot designs compared with cruciate-retaining designs in TKA without patellar resurfacing. Clin Orthop Relat Res 478(6):1207–1218CrossRefPubMedPubMedCentral Øhrn FD, Gøthesen Ø, Låstad Lygre SH, Peng Y, Lian ØB, Lewis PL et al (2020) Decreased survival of medial pivot designs compared with cruciate-retaining designs in TKA without patellar resurfacing. Clin Orthop Relat Res 478(6):1207–1218CrossRefPubMedPubMedCentral
30.
go back to reference Samy DA, Wolfstadt JI, Vaidee I, Backstein DJ (2018) A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient-reported and radiographic outcomes. J Arthroplast 33(5):1379–1383CrossRef Samy DA, Wolfstadt JI, Vaidee I, Backstein DJ (2018) A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient-reported and radiographic outcomes. J Arthroplast 33(5):1379–1383CrossRef
31.
go back to reference Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new Knee Society Knee Scoring system. Clin Orthop Relat Res 470(1):3–19CrossRefPubMed Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new Knee Society Knee Scoring system. Clin Orthop Relat Res 470(1):3–19CrossRefPubMed
32.
go back to reference Shi W, Jiang Y, Wang C, Zhang H, Wang Y, Li T (2020) Comparative study on mid- and long-term clinical effects of medial pivot prosthesis and posterior-stabilized prosthesis after total knee arthroplasty. J Orthop Surg Res 15(1):421CrossRefPubMedPubMedCentral Shi W, Jiang Y, Wang C, Zhang H, Wang Y, Li T (2020) Comparative study on mid- and long-term clinical effects of medial pivot prosthesis and posterior-stabilized prosthesis after total knee arthroplasty. J Orthop Surg Res 15(1):421CrossRefPubMedPubMedCentral
33.
go back to reference Taniguchi N, Matsuda S, Kawaguchi T, Tabara Y, Ikezoe T, Tsuboyama T et al (2015) The KSS 2011 reflects symptoms, physical activities, and radiographic grades in a Japanese population. Clin Orthop Relat Res 473(1):70–75CrossRefPubMed Taniguchi N, Matsuda S, Kawaguchi T, Tabara Y, Ikezoe T, Tsuboyama T et al (2015) The KSS 2011 reflects symptoms, physical activities, and radiographic grades in a Japanese population. Clin Orthop Relat Res 473(1):70–75CrossRefPubMed
34.
go back to reference Tsukiyama H, Kuriyama S, Kobayashi M, Nakamura S, Furu M, Ito H et al (2017) Medial rather than lateral knee instability correlates with inferior patient satisfaction and knee function after total knee arthroplasty. Knee 24(6):1478–1484CrossRefPubMed Tsukiyama H, Kuriyama S, Kobayashi M, Nakamura S, Furu M, Ito H et al (2017) Medial rather than lateral knee instability correlates with inferior patient satisfaction and knee function after total knee arthroplasty. Knee 24(6):1478–1484CrossRefPubMed
35.
go back to reference Wautier D, Thienpont E (2017) Changes in anteroposterior stability and proprioception after different types of knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(6):1792–1800CrossRefPubMed Wautier D, Thienpont E (2017) Changes in anteroposterior stability and proprioception after different types of knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(6):1792–1800CrossRefPubMed
Metadata
Title
Medial pivot-based total knee arthroplasty achieves better clinical outcomes than posterior-stabilised total knee arthroplasty
Authors
Michitaka Kato
Hideki Warashina
Shingo Mitamura
Akito Kataoka
Publication date
12-09-2022
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-07149-2

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