Medially stabilized TKA may yield better quality of life vs cruciate-retaining TKA
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Use of a medially stabilized knee system during total knee arthroplasty may restore patient quality of life compared with a cruciate-retaining knee system, according to published results.
Researchers randomly assigned 103 patients undergoing TKA to receive either the Vanguard Cruciate-Retaining Knee (Zimmer Biomet; n=50) or the medially stabilized SAIPH Knee System (Matortho; n=53). Researchers collected range of motion, KOOS, KOOS-12, KOOS-short form, KOOS-joint replacement, Oxford Knee Score, WOMAC index, University of California, Los Angeles activity scale and EuroQol-5D preoperatively and 1 year postoperatively, as well as the forgotten joint score and VAS-satisfaction at 1 year postoperatively.
At 1-year follow-up, researchers received complete data from 44 patients who received the cruciate-retaining knee system and 46 patients who received the medially stabilized knee system. Results showed significantly better forgotten joint score, KOOS-12 quality of life (QoL) subscale and KOOS QoL subscale among patients who received the medially stabilized knee system compared with patients who received the cruciate-retaining knee system. However, researchers found no differences in all assessed patient-reported outcome measures or range of motion between the two groups preoperatively and at 1 year postoperatively.
“These findings suggest that the [medially stabilized] MS design is advantageous in facilitating high-end function and restoring quality of life,” the authors wrote. “It may allow patients to move closer to the ultimate goal in arthroplasty of allowing them to forget their joint has been replaced.” – by Casey Tingle
Disclosures: French reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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David F. Scott, MD
This paper by Sofie R. French, BPsych(Hons), and colleagues illustrates at least two important points with respect to patient satisfaction after TKA:
1) Cruciate retaining knees (as well as posterior stabilized knees) may be ACL-deficient in mid-flexion, yet medially stabilized knees are stable throughout full range of motion. Mid-flexion stability is hypothesized as one determinant of patient satisfaction; knee designs, such as medially stabilized that preserve mid-flexion stability better than others, may improve patient-reported outcome measures and satisfaction.
2) Medially stabilized knee designs and kinematic alignment principles are complementary in that they are both respectful of the individual patient’s unique anatomy. Preservation of the native joint lines and compartment pressures/collateral tension (kinematic alignment) have been shown in numerous reports to improve patient outcomes. The combination of kinematic alignment with a more anatomic implant design achieves synergies which may optimize outcomes after TKA, as suggested by this study, and together may represent the “state-of-the-art.”
TKA outcomes and patient satisfaction lag behind those obtained with hip arthroplasty, thus any technique and/or implant design that improves these metrics is welcome. This is a valuable addition to our fund of knowledge and should encourage additional studies of a similar nature.
Clinical instructor
Seattle
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