Abstract
Background:Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer.Objective:The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature.Material and Methods:This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available.Results:Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes.Conclusion:When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant.
Highlights
Total knee arthroplasty (TKA), though primarily considered a successful procedure, has been associated with post-surgical functional deficits in activities of daily living [1, 2]
Five knees (1.9%) were observed mimicking iliotibial band (ITB) friction syndrome, three (2.0%) in the bi-cruciate stabilized (BCS) I group and two (1.9%) in the BCS II group (p = 0.676)
In addition to ITB, we observed five knees (1.9%) with mild instability in midflexion, of which three (2.0%) were in the BCS I group and 2 (2.9%) were in the BCS II group (p = 0.676)
Summary
Total knee arthroplasty (TKA), though primarily considered a successful procedure, has been associated with post-surgical functional deficits in activities of daily living [1, 2]. Hommel and Wilke deficits, several new knee implants were introduced in recent years that seek to obtain improved stability and higher flexion One such implant (Journey Bi-Cruciate Stabilized [BCS], Smith & Nephew, Memphis, TN, USA) recreates a specific kinematic model through the principle of guided motion [3]. Guided motion is obtained via the asymmetric tibiofemoral surface geometry and cam-post design, the latter of which guides the femur to external rotation in flexion in relation to the tibia and in full extension to the screw-home mechanism The function of both the anterior cruciate ligament and posterior cruciate ligament is replicated by the post-cam’s ability to engage posteriorly as well as anteriorly [5]. Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer
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