engleski

Posterior cruciate ligament - retaining versus cruciate-sacrificing total knee arthroplasty in patients with rheumatoid arthritis

Controversy persists concerning posterior cruciate ligament retention in total knee arthroplasty for patients with rheumatoid arthritis (1). Posterior instability which develops as a result of the destruction of the retained PCL following disease progression (2), is considered a source of persistent pain and functional impairment following total knee arthroplasty (3, 4). The aim of the study is to compare functional and radiological outcomes of cruciate sacrificing (PCL stabilising)and cruciate retaining of cemented total knee prosthesis in patients with rheumatoid arthritis knee destruction. We analysed 60 knees in patients with rheumatoid arthritis with implanted cemented total knee prosthesis. The patients were divided in two groups. The 30 patients in the first group were implanted with posterior cruciate retaining knee prosthesis (DePuy, PFC Sigma CR), while the posterior cruciate ligaments of patients in the second group of 30 were sacrificing (DePuy, PFC Sigma CS). The average age in both groups was 67 years (57- 75) and the average follow-up period 5 years (3-­8). We evaluated the Hospital for Special Surgery Knee score, knee flexion, correction of deformity, patient satisfaction with surgery and radiographic analysis of radiolucency. The mean Knee Society functional scores improved, rising from 36 points (range 25 - 60) to 73 points (range 60 - 90) for the cruciate- retaining group, and from 34 points (range 23 - 58) to 75 points (range 60 - 100) for the cruciate-sacrificing group. Final follow-up revealed that knee flexion was approximately 1050 (range 70 - 120°) and 110° (range 70 - 125°) in the cruciate-retaining and posterior-stabilized groups, respectively. In both groups we achieved an average 60 of valgus. In both groups the patients reported major pain relief and satisfaction with surgery. We did not observe significant radiolucency in the follow-up period in either group, nor any other clinical signs of loosening. On the basis of our study we could not observe the superiority of one knee arthroplasty design over the other. We thus suggest using PCL retaining knee prosthesis design in patients with rheumatoid arthritis, because this model preserves much more bone stock, which is important in potential knee revision arthroplasty. References: 1.Dorr LD, Oschner JL, Gronley J, Perry J. Functional comparison of posterior cruciate retained versus sacrificed total knee arthroplasty. Clin Orthop 1988 ; 236:36-43. 2.Nelissen RGHH, Hogendoorn PCW. Retain or sacrifice the posterior cruciate ligament in total knee arthroplasty? A histopathological study of the cruciate ligament in osteoarthritic and rheumatoid disease. J Clin Pathol 2001 ; 54:381–4. 3. Laskin RS, O'Flynn HM. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications. Clin Orthop 1997 ; 345:24–8. 4. Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ. Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop 1998 ; 356:39–46.

rheumatoid arthritis; posterior cruciate ligament; total knee arthroplasty

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