Σύγκριση των Κινηματικών και Κλινικών Αποτελεσμάτων Μεταξύ Προθέσεων Οπίσθιας και Πρόσθιας Σταθεροποίησης στην Ολική Αρθροπλαστική Γόνατος με Αντικατάσταση του Οπίσθιου Χιαστού Συνδέσμου: Συστηματική Βιβλιογραφική Ανασκόπηση
Creators: name: Παντελίδης, Εμμανουήλ Κωνσταντίνου
Publisher: name: Aristotle University of Thessaloniki
Year: 2024
Subjects: Ολική αρθροπλαστική γόνατος πρόσθιας/ οπίσθιας σταθεροποίησης
Οπίσθιος χιαστός σύνδεσμος
Κινηματική του γόνατος
Anterior-/Posterior- Stabilized total knee arthroplasty
Posterior cruciate ligament
Knee kinematics

description: Κέλλης, Ελευθέριος, καθ. Τεφαα Σερρών Κουτλιάνος, Νικόλαος, καθ. Τεφαα Θεσσαλονίκης
description: Introduction: One of the biggest debates concerning total knee arthroplasty (TKA) remains the treatment of posterior cruciate ligament (PCL), with the decision to preserve or sacrifice it relying in many cases upon the surgeon’s personal preference. Current literature however clearly favors PCL substitution in certain scenarios that more often than not accompany severe knee osteoarthritis and then the debate about the optimal prostheses type arises. With posterior-stabilized (PS) TKA designs currently presenting the most popular choice, anterior-stabilized (AS) designs with an ultra-congruent (UC) tibial polyethylene insert and a typical femoral component propose an interesting alternative. So far, kinematic and clinical outcomes remain inconclusive about the overall superiority of one implant type over the other. Purpose: To investigate the current concepts and concerns regarding the substitution of PCL in TKA from a kinematic and clinical perspective and compare the kinematic, functional and clinical outcomes of AS and PS TKA designs. Study Design: Systematic review. Data Sources: PubMed, Scopus and Google Scholar databases were researched for related articles in September 2023. Methods: Search was performed within the timeframe of the last 30 years with a primary focus towards systematic literature reviews and meta-analyses, literature reviews, RCTs, retrospective clinical studies and experimental studies concerning the comparison of kinematic, functional and clinical outcomes between AS and PS TKA as well as patient reported satisfaction. Additional literature regarding the natural knee kinematics, reported kinematic and clinical outcomes after different types of TKA, related complications, prosthesis survivorship and long-term results was also included. Results: 149 were utilized in order for this paper to be written, from which 12 were RCTs comparing the kinematic, functional and clinical outcomes between AS and PS TKA. 3 of these articles were intra-operative kinematic studies, 9 were radiologically or fluoroscopically assessing post-operative kinematics and 5 were in vitro or in silico experimental movement simulation studies. Conclusion: Despite the mainly inconclusive evidence, most studies support AS TKA as an appropriate alternative to the PS design. Although UC polyethylene causes greater sagittal laxity, inferior femoral rollback and potentially reduced ROM in comparison to the post and cam mechanism and while neither design adequately replicates natural knee kinematics, no substantial difference seems to exist in the postoperative functional, clinical and patient-reported outcomes. Dual pivot and mobile-bearing (MB) implants shall further improve postoperative axial rotation. The increased congruity of AS design does not lead to accelerated polyethylene wear and implant loosening and prosthesis survivorship does not seem to be jeopardized. More prospective RCTs are mandatory to evaluate the long-term outcomes of AS TKA.