Comparable outcomes between cruciate-substituting and posterior-stabilized inserts in robotic total knee arthroplasty under the functional alignment principles.

IF 3.3 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-13 DOI:10.1002/ksa.12654

Christos Koutserimpas, Pietro Gregori, Luca Andriollo, Elvire Servien, Cécile Batailler, Sébastien Lustig

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引用次数: 0

Abstract

Purpose: Functional alignment (FA) has emerged as a personalized strategy in total knee arthroplasty (TKA) to optimize outcomes by accounting for patient-specific anatomical and soft tissue characteristics. Limited evidence exists on how polyethylene insert type, specifically cruciate-substituting (CS) versus posterior-stabilized (PS), impacts clinical outcomes and complications in this context.

Methods: This retrospective comparative study included 329 patients who underwent robotic-assisted TKA with FA principles with a minimum 2-year follow-up. Patients were divided into two groups: CS or PS implants. CS inserts were selected for patients with an intact posterior cruciate ligament (PCL), while PS inserts were used in cases of PCL insufficiency or significant flexion contractures. Preoperative and post-operative outcomes, including Knee Society Scores (KSS), Forgotten Joint Scores (FJS), range of motion (ROM) and complications, were assessed. Implant survivorship was analyzed using the Kaplan-Meier method.

Results: At a median follow-up of 36 months, no significant differences were observed between CS and PS groups in KSS (knee: p = 0.45; function: p = 0.4), FJS (p = 0.7) or ROM (median flexion: 130° in both groups, p = 0.52). Specific complications included intraoperative lateral condyle fractures in the PS group and femoral component revisions due to instability in the CS group. The overall complication rates and implant survivorship were comparable (p = 0.55 and p = 0.85, respectively).

Conclusion: This study is the first to evaluate polyethylene insert type in FA and demonstrates that both CS and PS inserts provide comparable outcomes and safety profiles in robotic-assisted TKA. These findings underscore the importance of patient-specific implant selection, with further research needed to assess long-term results.

Level of evidence: Level III.

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).