Abstract
BackgroundWe sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems. We also assessed whether the PCO and PCOR changes, as well as patient factors were related to range of motion (ROM) in each referencing system.MethodsThis retrospective study included 130 consecutive patients (184 knees) with osteoarthritis who underwent primary posterior cruciate ligament (PCL)-substituting fixed-bearing TKA. The difference between preoperative and postoperative PCO and PCOR values were calculated. Clinical outcomes including ROM and Western Ontario and McMaster University (WOMAC) scores were evaluated. Furthermore, multiple linear regression analysis was performed to determine the factors related to postoperative ROM in each referencing system.ResultsThe postoperative PCO was greater in the AR group (28.4 mm) than in the PR group (27.4 mm), whereas the PCO was more consistently preserved in the PR group. The mean postoperative ROM after TKA was greater in the AR group (129°) than in the PR group (122°), whereas improvement in WOMAC score did not differ between the two groups. Preoperative ROM was the only factor related to postoperative ROM in both groups.ConclusionsThere was no difference in postoperative PCO in AR and PR group and the PCO was not associated with postoperative ROM. PCO was more consistently preserved after surgery in the PR group. The postoperative PCO and PCOR changes did not affect the postoperative ROM. Furthermore, similar clinical outcomes were achieved in the AR and PR groups.Trial registrationRetrospectively registered (Trial registration number: 06-2010-110).
Highlights
We sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems
The mean postoperative range of motion (ROM) and its improvement after TKA were greater in the AR group than the PR group, whereas improvement in WOMAC score did not differ between the two groups
The principal findings of this study were: 1) There was no difference in postoperative PCO in AR and PR group and the PCO was more consistently preserved in the PR group; 2) changes in PCO
Summary
We sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems. Proper implant positioning and sizing are crucial for successful total knee arthroplasty (TKA) [1,2,3,4]. Anterior referencing (AR) and posterior referencing (PR) systems are the two major systems for positioning and sizing of the femoral component. The posterior condylar resection is set in the PR system, whereas the anterior femoral cutting is less predictable [5]. If there is increased flexion gap during surgery in the AR system, it could be compensated with by up-sizing the femoral component without mediolateral overhang. There are implants that have a femoral component with an increased cutting angle of the anterior flange to avoid AFC notching, and down-sizing the femoral component is possible in the PR system
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