Does an Anterior-Lipped Tibial Insert Adequately Substitute for a Post-Cam Articulation in Total Knee Arthroplasty

Rahul K. Biyani, Mary Ziemba-Davis, Philip H. Ireland, R. Meneghini

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

INTRODUCTION: Newer tibial inserts with enhanced conformity (cruciate stabilizing anterior lip; CS) to obviate the need for a posteriorly stabilized (PS) post-cam articulation in posterior cruciate ligament-deficient knees have been recently introduced in modern total knee arthroplasty (TKA). The purpose of this study was to evaluate whether clinical and functional outcomes differ in TKA cohorts without a posterior cruciate ligament (PCL) utilizing either CS anterior-lipped or PS post-cam articulation. MATERIALS AND METHODS: Prospectively collected outcomes were compared in matched cohorts of modern TKAs implanted with either CS anterior-lipped tibial inserts or PS post-cam articulations. The PCL was resected in all knees. Modern Knee Society Scores (objective, function, and satisfaction scores), walking and stair pain, EuroQol five dimensions (EQ-5D) health-related quality of life, and UCLA activity level were assessed at minimum one-year follow-up. RESULTS: Forty-three anterior-lipped and 39 PS TKAs were matched on sex, age, BMI, and ASA classification at the time of surgery and months of follow-up. CS knees had significantly higher preoperative function scores than PS knees (p = 0.033), but both groups had equivalent function scores at minimum follow-up of one-year (p = 0.687). Eight-one percent of patients in each group reported being satisfied or very satisfied with their TKA (X2 = 0.072, p = 0.964). CONCLUSIONS: This study supports the hypothesis that an anterior-lipped insert is an adequate functional substitute for a post-cam articulation in patients undergoing TKA with PCL excision. These findings suggest that a PS post-cam articulation may not be necessary given the introduction, availability, and clinical performance of anterior-lipped and more conforming tibial bearings. Further study and longer term follow-up is warranted.

Original languageEnglish (US)
Pages (from-to)341-345
Number of pages5
JournalSurgical technology international
Volume30
StatePublished - Jul 25 2017

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Posterior Cruciate Ligament
Knee Replacement Arthroplasties
Knee
Lip
Walking
Quality of Life
Pain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Does an Anterior-Lipped Tibial Insert Adequately Substitute for a Post-Cam Articulation in Total Knee Arthroplasty. / Biyani, Rahul K.; Ziemba-Davis, Mary; Ireland, Philip H.; Meneghini, R.

In: Surgical technology international, Vol. 30, 25.07.2017, p. 341-345.

Research output: Contribution to journalArticle

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title = "Does an Anterior-Lipped Tibial Insert Adequately Substitute for a Post-Cam Articulation in Total Knee Arthroplasty",
abstract = "INTRODUCTION: Newer tibial inserts with enhanced conformity (cruciate stabilizing anterior lip; CS) to obviate the need for a posteriorly stabilized (PS) post-cam articulation in posterior cruciate ligament-deficient knees have been recently introduced in modern total knee arthroplasty (TKA). The purpose of this study was to evaluate whether clinical and functional outcomes differ in TKA cohorts without a posterior cruciate ligament (PCL) utilizing either CS anterior-lipped or PS post-cam articulation. MATERIALS AND METHODS: Prospectively collected outcomes were compared in matched cohorts of modern TKAs implanted with either CS anterior-lipped tibial inserts or PS post-cam articulations. The PCL was resected in all knees. Modern Knee Society Scores (objective, function, and satisfaction scores), walking and stair pain, EuroQol five dimensions (EQ-5D) health-related quality of life, and UCLA activity level were assessed at minimum one-year follow-up. RESULTS: Forty-three anterior-lipped and 39 PS TKAs were matched on sex, age, BMI, and ASA classification at the time of surgery and months of follow-up. CS knees had significantly higher preoperative function scores than PS knees (p = 0.033), but both groups had equivalent function scores at minimum follow-up of one-year (p = 0.687). Eight-one percent of patients in each group reported being satisfied or very satisfied with their TKA (X2 = 0.072, p = 0.964). CONCLUSIONS: This study supports the hypothesis that an anterior-lipped insert is an adequate functional substitute for a post-cam articulation in patients undergoing TKA with PCL excision. These findings suggest that a PS post-cam articulation may not be necessary given the introduction, availability, and clinical performance of anterior-lipped and more conforming tibial bearings. Further study and longer term follow-up is warranted.",
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AU - Ireland, Philip H.

AU - Meneghini, R.

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N2 - INTRODUCTION: Newer tibial inserts with enhanced conformity (cruciate stabilizing anterior lip; CS) to obviate the need for a posteriorly stabilized (PS) post-cam articulation in posterior cruciate ligament-deficient knees have been recently introduced in modern total knee arthroplasty (TKA). The purpose of this study was to evaluate whether clinical and functional outcomes differ in TKA cohorts without a posterior cruciate ligament (PCL) utilizing either CS anterior-lipped or PS post-cam articulation. MATERIALS AND METHODS: Prospectively collected outcomes were compared in matched cohorts of modern TKAs implanted with either CS anterior-lipped tibial inserts or PS post-cam articulations. The PCL was resected in all knees. Modern Knee Society Scores (objective, function, and satisfaction scores), walking and stair pain, EuroQol five dimensions (EQ-5D) health-related quality of life, and UCLA activity level were assessed at minimum one-year follow-up. RESULTS: Forty-three anterior-lipped and 39 PS TKAs were matched on sex, age, BMI, and ASA classification at the time of surgery and months of follow-up. CS knees had significantly higher preoperative function scores than PS knees (p = 0.033), but both groups had equivalent function scores at minimum follow-up of one-year (p = 0.687). Eight-one percent of patients in each group reported being satisfied or very satisfied with their TKA (X2 = 0.072, p = 0.964). CONCLUSIONS: This study supports the hypothesis that an anterior-lipped insert is an adequate functional substitute for a post-cam articulation in patients undergoing TKA with PCL excision. These findings suggest that a PS post-cam articulation may not be necessary given the introduction, availability, and clinical performance of anterior-lipped and more conforming tibial bearings. Further study and longer term follow-up is warranted.

AB - INTRODUCTION: Newer tibial inserts with enhanced conformity (cruciate stabilizing anterior lip; CS) to obviate the need for a posteriorly stabilized (PS) post-cam articulation in posterior cruciate ligament-deficient knees have been recently introduced in modern total knee arthroplasty (TKA). The purpose of this study was to evaluate whether clinical and functional outcomes differ in TKA cohorts without a posterior cruciate ligament (PCL) utilizing either CS anterior-lipped or PS post-cam articulation. MATERIALS AND METHODS: Prospectively collected outcomes were compared in matched cohorts of modern TKAs implanted with either CS anterior-lipped tibial inserts or PS post-cam articulations. The PCL was resected in all knees. Modern Knee Society Scores (objective, function, and satisfaction scores), walking and stair pain, EuroQol five dimensions (EQ-5D) health-related quality of life, and UCLA activity level were assessed at minimum one-year follow-up. RESULTS: Forty-three anterior-lipped and 39 PS TKAs were matched on sex, age, BMI, and ASA classification at the time of surgery and months of follow-up. CS knees had significantly higher preoperative function scores than PS knees (p = 0.033), but both groups had equivalent function scores at minimum follow-up of one-year (p = 0.687). Eight-one percent of patients in each group reported being satisfied or very satisfied with their TKA (X2 = 0.072, p = 0.964). CONCLUSIONS: This study supports the hypothesis that an anterior-lipped insert is an adequate functional substitute for a post-cam articulation in patients undergoing TKA with PCL excision. These findings suggest that a PS post-cam articulation may not be necessary given the introduction, availability, and clinical performance of anterior-lipped and more conforming tibial bearings. Further study and longer term follow-up is warranted.

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