Posterior Cruciate-Retaining vs Posterior Cruciate-Stabilized Prosthesis in Total Knee Arthroplasty: A Meta-Analysis

To evaluate the clinical and imaging results of posterior cruciate-retaining vs the posterior cruciate-stabilized method in total knee arthroplasty (TKA).

PubMed, EMbase and Cochrane Library databases were used to retrieve randomized controlled trials (RCTs) concerning the posterior cruciate-retaining vs posterior cruciate-stabilized method in TKA. Determination of study quality and data extraction were performed by 2 reviewers. Study heterogeneity was assessed by ReviewManager (RevMan) software and meta-analysis was conducted.

A total of 15 RCTs were finally included in our meta-analysis. The results showed that no significant differences were found in the American Knee Society Score (AKSS) (MD = 0.13; 95% CI, -0.73 to 1.00), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MD = 0.59; 95% CI, 0.00-1.18), knee extension range of motion (MD = 0.10; 95% CI, -0.30 to 0.51)] or posterior tibial slope (MD = -0.09; 95% CI, -0.52-0.33) after surgery between the 2 groups. Compared with the posterior cruciate-retaining prosthesis group, in the posterior cruciate-stabilized prosthesis group the active knee joint range of motion was significantly increased (MD = -6.99; 95% CI, -9.17 to -4.81), knee flexion was significantly increased (MD = -4.22; 95% CI, -6.03 to -2.41) and the mechanical tibial angle was closed to 6° (MD = 0.85; 95% CI, 0.46-1.25). There were no significant differences in residual knee pain (OR = 1.26; 95% CI, 0.57-2.78), infection rate at the surgical site (OR = 0.50, 95% CI, 0.13-1.88) or revision rate (OR = 0.59; 95% CI, 0.15-2.32) between the 2 groups. Funnel plot revealed no significant bias in the included studies.

In summary, patients who received a posterior cruciate-stabilized prosthesis had better knee joint active range of motion, knee flexion and mechanical femorotibial angle than patients who received a posterior cruciate-retaining prosthesis. Due to the surgical difficulty involved in a posterior cruciate-retaining prosthesis, junior doctors should choose a posterior cruciate-stabilized prosthesis first, and senior doctors should choose the prosthesis according to the patient's condition and the surgeon's proficiency at performing the surgery in question.