Cruciate Substituting Implants in Primary Total Knee Arthroplasty.

Alexander J Volkmar,Robert Elrod,J Ryan Martin,Charlie C Yang,Gregory G Polkowski,Justin W Vickery,Francesco Liuzza

doi:10.1155/2022/2676715

Alexander J Volkmar, Robert Elrod + Show 5 more

Open Access

https://doi.org/10.1155/2022/2676715

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Abstract

The use of cruciate substituting (CS) total knee replacement has been increasing in popularity. There are numerous factors that have likely contributed to this expansion. The CS philosophy incorporates the ease of use commonly cited by advocates of the posterior stabilized (PS) total knee design with the bone preservation associated with a cruciate retaining (CR) design. The ultra-congruent highly cross-linked polyethylene liner increases stability without an appreciable change in wear. Furthermore, balancing the flexion and extension gaps does not require “titrating” the posterior cruciate ligament, improving the user-friendliness. This paper reviews the nuances of this implant design compared to PS and CR designs as well as provides surgical technique recommendations/considerations.

Highlights

Initial emphasis was placed on the concept of femoral rollback and posterior translation of the femur on the tibia in the sagittal plane as the knee flexes
Additional attention has been placed on restoration of axial rotation and posterior translation of the lateral femur as the knee enters deep flexion [10, 11]. is motion has been referred to as “medial pivot” [12]
While cruciate retaining (CR), posterior stabilized (PS), and cruciate substituting (CS) implants have been utilized for years, the CS implants were initially not favorable due to earlier designs using ultra-congruent implants on standard cross-linked polyethylene

Summary

Introduction

Any arthrotomy can be utilized; the authors prefer to use a standard medial parapatellar approach. E sequence of ligamentous releases and bony resections is surgeon dependent, and the use of a CS implant should not necessarily change this process. E authors prefer a gap-balancing technique; measured resection, kinematic alignment, and technology-assisted techniques can be applied. Especially with gap-balancing techniques, early release of the PCL should be considered. Late release of the PCL can increase the flexion gap, which may require subsequently increasing the extension gap to achieve symmetry. In measured resection techniques, late release can be considered. In surgeons that are considering transitioning to this implant from a CR methodology, release of the PCL to balance the flexion/extension gap and use of an ultra-congruent liner could be considered rather than transitioning to a PS implant

Discussion

Conclusion