Posterior Cruciate-stabilizing Versus Posterior Cruciate-retaining Total Knee Prostheses: A Meta-analysis Of A Short-term Follow-up Study

Objective: Presently, Total knee arthroplasty (TKA) is widely acceptedall over the world and keep developing quickly. From the20century70years,after the early total condylar knee arthroplasty, there is a great debate aboutthe advantages of Posterior Cruciate-Stabilizing or PosteriorCruciate-Retaining Total Knee Prostheses in their co-development process. Alot of long-term follow-up study shows that there are no obvious differenceson the range of motion, satisfaction of patients, and prostheses survival from10to15years and major clinical manifestations. In fact, scholars have foundthat whether the total knee arthroplasty succeed or not is affected by manyfactors by analyzing the differences on the design of these two types ofprostheses.By the short-term follow-up study, we mainly analyze the differencesbetween Posterior Cruciate-Stabilizing or Posterior Cruciate-Retaining TotalKnee Prostheses by measuring anterior-posterior displacement, blood loss, therange of motion (ROM) and the American Knee Society Knee Scores (AKS)after total knee arthroplasty.Methods: We take109patients who had one side total knee arthroplastyfor sample in the third hospital of Hebei Medical University from February of2011to July of2012. They are from47to80years old, and their average ageis63years. There are62patients (54female,8male), amounting to62knees,who take the Posterior Cruciate-Retaining Total Knee Prostheses in Team A.Their average age is63years, and there are28left knees and34right knees.Their body mass index (BMI) is27.77±3.41, preoperative range of motion is99.59±10.09, preoperative clinical score is49.92±5.59, and preoperativefunctional score is34.92±6.56. There are47patients (34female,13male), amounting to47knees, who take the Posterior Cruciate-Stabilizing Total KneeProstheses in Team B, their average age is63years, and there are21left kneesand26right knees, BMI is27.22±3.38, preoperative range of motion is101.06±11.27, preoperative clinical score is50.04±6.51, and preoperativefunctional score is34.68±6.63. Posterior Cruciate-Retaining Total KneeProstheses is produced by Link Company and Posterior Cruciate-StabilizingTotal Knee Prostheses is produced by Stryker Company. There are no statisticsdifferences at the average ages and BMI of those patients in two Teams. Allthose medical case were not patellar resurfacing. All those patients took bloodroutine examination on an empty stomach before TKA and on the morning ofthe second day after TKA, and we recorded the consistency of HGB, made itsvariation to represent the amount of blood loss. At one month, and threemonths postoperatively, all the patients came back to the hospital and didreview, measuring maximum anterior-posterior displacement of knee by theKT-1000knee arthrometer when it appears30°flexion, and make recordsthe ROM as well as AKS. In the process of operating KT-1000, the patientsshould lies in supine position, and knees need to be relax totally, the doctorsplace the KT-1000knee arthrometer properly, and press downward withproper pressure at tubercles of tibia, measuring the maximumanterior-posterior displacement of knee with upward pull manually. TheAmerican Knee Society Knee Scores, including clinical scores and thefunctional scores, the author makes the records in details in the follow-upobservation. And the author analysis the difference on amount of blood loss,the maximum anterior-posterior displacement of knee, ROM and AKS afterPosterior Cruciate-Stabilizing or Posterior Cruciate-Retaining Total KneeArthroplasty by SPSS20.0software.Results: All the patients took the blood routine examination on thesecond day, the hemoglobin consistency decreased at31.16±5.20g/L in TeamA and it decreased at33.45±4.54g/L in Team B, there’s statistical significanceon the difference of the hemoglobin consistency variation (P<0.05). Theamount of blood loss of the patients in team A was slightly less than in team B. At3months postoperatively, the maximum anterior-posterior displacement ofknee in Team A was9.73±2.82mm, and it was8.61±2.03mm in Team B.There’s statistical significance on the difference of the maximumanterior-posterior displacement (P<0.05). The maximum anterior-posteriordisplacement of team A is slightly bigger than Team B. In team A, the kneerange of motion was121.3±11.9°, and in team B, it was120.4±10.3°, there isno statistical significance on the difference of the knee range of motion(P>0.05). At3months postoperatively, American Knee Society Knee Scoreswas applied in the review, the clinical score is86.5±5.5in Team A, and it was87.1±4.4in Team B. There is no statistical significance on the difference ofclinical score (P>0.05). There is no obvious difference on AKS clinical scorebetween Team A and Team B. As to the AKS functional score, it conforms tothe skewed distribution, and we take the nonparametric test. There is nostatistical significance on the difference of AKS functional score (P>0.05),and there is no obvious difference on AKS functional score between Team Aand Team B.Conclusion: The amount of blood loss of the patients who choose thePosterior Cruciate-Stabilizing Total Knee Prostheses is more than the patientswho choose the Posterior Cruciate-Retaining Total Knee Prostheses on thesecond day after the TKA. The maximum anterior-posterior displacement ofknee of the patients who choose the Posterior Cruciate-Stabilizing Total KneeProstheses is shorter than the patients who choose the PosteriorCruciate-Retaining Total Knee Prostheses at3months postoperatively. Thereis no obvious difference on the ROM and AKS between the patients whochoose the Posterior Cruciate-Stabilizing or Posterior Cruciate-Retaining TotalKnee Prostheses at3months postoperatively.We know that Posterior Cruciate-Retaining Total Knee Prostheses is moresuperior to Posterior Cruciate-Retaining Total Knee Prostheses on maintainingthe knee stability because the maximum anterior-posterior displacement ofknee of the Posterior Cruciate-Stabilizing Total Knee Prostheses is muchshorter. In the long-term follow-up study, Posterior Cruciate-Stabilizing Total Knee Prostheses may have the longer application life. Making the variation ofthe consistency of HGB to represent the amount of blood loss, there isstatistical significance on the amount of blood loss between the PosteriorCruciate-Retaining Total Knee Prostheses and Posterior Cruciate-StabilizingTotal Knee Prostheses in the Perioperative period, but there is no clinicalmeaning because of the smaller difference, even though so we can’t claim thatthere is different on the amount of blood loss between those two prostheses.There is no obvious difference on the knee range of motion and AKS, and theyboth get the satisfaction of the patients. It illustrates that those prostheses hasthe good effect on functional rehabilitation after TKA even though they hasnuance in some aspects.