Abstract
Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating patients who underwent total knee arthroplasty with a posterior stabilized design.
 Material and methods: The study included a total of 68 knees of 52 patients with completed follow-up data who underwent PCL substituting (PS) total knee arthroplasty due to a diagnosis of primary or secondary osteoarthritis. The 52 patients comprised 45 (86.5%) females and 7 (13.5%) males with a mean age of 65.2±9.32 years (range, 30-82 years). The American Knee Society criteria were adopted for assessment of patient knee scores and functional knee scores. The Total Knee Prosthesis Radiological Evaluation criteria were applied for radiological evaluation of the patients.
 Results: The mean follow-up period of the patients was 32.1 ± 9.85 months (range: 18-60 months) and the Knee Society Scores (KSS) were 41.5 (range: 26 - 58) preoperatively, and 84.3 (range: 51 - 97) postoperatively. The mean preoperative and postoperative range of motion was 88.2º (range: 60º - 100º), and 106.7º (range: 90º - 120º), respectively. Two-stage revision surgery was applied to one patient due to deep infection. No cases of aseptic loosening were observed. Implant survivorship, and excellent and good results according to the functional knee score were reported as 98.8%, 41.1%, and 32.3%, respectively.
 Conclusion: Positive patient outcomes were obtained with the use of PS total knee arthroplasty in patients with severe osteoarthritis and there was no evidence of loss in mid-term follow-up.
Highlights
One of the most fervent and long-term controversies in orthopedic surgery is the role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA)
The patients included in the study were treated with posterior stabilized implants due to grade IV osteoarthritis according to Kellgren-Lawrence grades and had completed an 18-month follow-up period
Patient characteristics and baseline demographics are presented in Table 1.During the 68 knee arthroplasty surgeries performed, the need for blood transfusion occurred in 14 procedures, and the mean number of transfusion units was calculated as 0.41 ± 0.72
Summary
One of the most fervent and long-term controversies in orthopedic surgery is the role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA). Excellent long-term clinical outcomes of TKA in designs of the cruciate-sacrificing, cruciate-substituting, and cruciate-retaining types have made it difficult for surgeons to decide [1]. In vitro studies have demonstrated that physiological posterior femoral translation over the tibia during flexion (femoral rollback) and reproducing the natural axial rotation of the femur (screw-home mechanism) provide an improvement in the function of the extensor mechanism and increased knee flexion. Compared to a healthy knee joint, the above-mentioned joint functions are decreased after TKA, PS designs provide better femoral rollback and greater knee flexion than ligament preserving designs [4]
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