Indications for bi-cruciate retaining total knee replacement: An international survey of 346 knee surgeons

There is limited evidence on total knee arthroplasty (TKA) that retains the anterior and the posterior cruciate ligaments. Bi-cruciate retaining (BCR) TKA is considered to show improved clinical function and kinematics. This survey aimed to (1) identify interest in and acceptance of BCR TKA surgery and (2) to capture the range of indications for BCR in the opinion of practicing knee surgeons. 346 surgeons with experience in TKA surgery completed a bi-lingual online survey. Demographics, arthroplasty experience as well as acceptance of and indications for BCR TKA were collected. 53 surgeons were experienced in BCR TKA and 225 would consider implanting it. A mean of 19.5% of TKA patients were considered eligible for BCR TKA. 56.3% were thought to have intact ACL at the time of TKA surgery. Surgeons were not likely to perform BCR TKA in patients with inflammatory arthritis, aged over 80, BMI above 34.9 kg/m2, a varus or valgus deformity of more than 10° and flexion contractures of more than 10°. There is strong interest among orthopedic surgeons to perform BCR TKA and the percentage of potentially eligible patients is high. Significant joint deformity is a limitation of BCR TKA, while age and high BMI are less relevant. BCR TKA experienced surgeons are less restrictive.