CORR Insights^®: Higher Frequency of Reoperation With a New Bicruciate-retaining Total Knee Arthroplasty

Excerpt

In their study, Christensen and colleagues suggest that the high risk of dissatisfaction among many total knee replacement patients may be a function of the fact that standard cruciate-retaining or cruciate-substituting prostheses do not result in natural knee kinematics [5, 6]. To try to address this, they performed a large, comparative (but not randomized) study in which they compared a new bicruciate-retaining prosthesis to a standard posterior cruciate-retaining implant. Unfortunately, patients receiving the new implant were more likely to undergo reoperation than those who received the standard posterior cruciate-retaining device. They are to be complimented on their willingness to report this, as well as the fact that it took longer to insert the new device, and that it did not seem to improve clinical outcome metrics or ROM at all. They were unable to establish whether the increased risk of early reoperation and extended operative time were the result of the surgical learning curve or to an inferior design. The fact that the patients were not randomized also left the reader unsure as to how patient selection played into the results. At the conclusion of this study, there is no indication that this prosthesis should be used in lieu of a standard posterior cruciate-retaining prosthesis. Although this bicruciate-prosthesis does not appear to be the answer—at least in the short-term—we should continue to look for solutions to improve patient reported outcomes following total knee replacement surgery. …