A PROSPECTIVE STUDY ON FUNCTIONAL OUTCOME IN POSTERIOR CRUCIATE RETAINING VERSUS POSTERIOR CRUCIATE SACRIFICING TOTAL KNEE ARTHROPLASTY
Authors: Mishra Dinesh , Dash Sunil Kumar 
Published: February 2022

Background: Total knee arthroplasty has evolved over the past decades into a very much reliable surgical treatment for
advanced arthritis of knee. Total knee replacement has been shown to restore patient function and relieve pain and
deformity that results from knee arthritis. The success of a total knee replacement is determined by many factors like
degree of pain relief and functional outcome. The role of Posterior cruciate ligament in total knee replacement is
controversial. The first is to retain the ligament and to preserve as much as possible of the
normal anatomy and function of the knee. Preservation of the ligament is thought to enhance stability, femoral rollback,
mechanical advantage of the quadriceps muscle and proprioceptive properties. Theoretically it has been suggested
that PCL retaining can increases the range of flexion and prevents posterior translation which reduces loosening and
excessive polyethylene wear by decreasing the shear stresses at the fixation surfaces. We conducted a prospective
study to compare resection with retention of PCL using a standard PCL–retaining cemented total knee replacement and
assessed the functional outcome using functional knee scores and WOMAC score.
Aims and Objectives: The aim of the study is to “prospectively compare the functional outcome between posterior
cruciate ligament retaining and posterior cruciate ligament sacrificing total knee arthroplasty.
Materials and Methods: The study was done on 20 patients admitted to Hi-Tech Medical College & Hospital,
Bhubaneswar. Scoring system formulated by the WOMAC Score, Knee Society Knee Score and Functional Knee Score
were used to evaluate the patients before and after surgery. Both knee scores and functional scores are calculated with
each amounting to a total of 100 points and WOMAC Score with max of 96 points. All patients were evaluated postoperatively and followed up.
Results: Analyzing the functional outcome it was found that all the patients in both the groups had significant
improvement in their knee score and the functional knee score. Analyzing the total Knee Scores, the average Knee
Society Score for the PS group was 85.80 and that of CR group was 75.60 and statistical analysis revealed a significant
difference in the the p-value in favour of Cruciate Sacrificing Prosthesis signifying that Cruciate Sacrificing Prosthesis
has better functional outcome. The functional knee society also showed a marked improvement in all patients, for CS
group FKS was 99.6 and for CR group it was 91.6.The WOMAC Score also showed a marked improvement. In CS groups it
was 24.6 and in CR it was 27.4. Statistical analysis showed a highly significant difference in favor of cruciate sacrificing
prosthesis.
Conclusions:Total Knee Arthroplasty in patients in whom posterior cruciate
ligament was sacrificed was found to have a better functional outcome as compared to the retaining group, which can be
mainly attributed to the persistence of flexion deformity in cruciate retaining group. In Indian scenario where knee
replacement is done at a late stage of osteoarthritis, sacrificing the contracted posterior cruciate ligament has better
outcomes as compared to retaining it.