Effect of posterior-stabilized and cruciate-retaining implants on three-dimensional kinematic characteristics after total knee arthroplasty

Abstract

Objectives: This study aimed to analyze the effects of posteriorstabilized (PS) and cruciate-retaining (CR) total knee arthroplasty (TKA) on early postoperative three-dimensional (3D) dynamic and kinematic characteristics in patients with unilateral knee osteoarthritis (OA).

Patients and methods: A retrospective analysis of prospectively collected data from 90 patients with unilateral TKA between February 2021 and September 2021 was conducted using a 3D kinematic analysis system before and six months after TKA. This patient group included 57 patients (10 males, 47 females; mean age: 69.5±7.5 years; range, 53 to 85 years) who underwent PS TKA and 33 patients (11 males, 22 females; mean age: 67.9±8.8 years; range, 45 to 86 years) who underwent CR TKA. The kinematic characteristics and clinical results of the two groups were compared. Clinical evaluation included the Hospital for Special Surgery knee score and range of motion (ROM). Twenty-eight healthy controls (9 males, 19 females; mean age: 64.5±2.9 years; range, 61 to 75 years) without knee OA matched for age, weight, height, and body mass index were recruited. The kinematic characteristics of the healthy control group were also evaluated.

Results: The PS group exhibited significant changes in basic gait parameters after TKA, including cadence (p=0.046), stride time (p=0.011), opposite foot off (p<0.001), opposite foot contact (p=0.038), step time (p=0.005), double support period (p<0.001), and foot off (p=0.004). No significant differences were observed in the kinematic parameters before and after TKA between the PS and CR groups, such as knee angle, moment, and force. The dynamic ROM of the CR group was greater than that of the PS group (p<0.001). Both the PS and CR groups showed significant deficiencies in flexion and extension function, including knee flexion moment, extension force, maximum flexion angle, and dynamic ROM, compared to healthy individuals. Throughout the gait cycle, both the PS and CR groups showed better knee joint stability compared to healthy individuals.

Conclusion: At six months postoperatively, both the PS and CR groups’ gait patterns did not recover to a healthy state, and the CR group’s gait pattern was more similar to OA. Compared to PS TKA, CR TKA allowed for greater dynamic ROM during gait. Despite exhibiting superior knee stability during gait, both implants’ knee kinematics function remained inferior compared to healthy individuals.

* These authors contributed equally to this work.
Citation: Gu C, Luo X, Liu H, Yu B, Fu M, Luo W. Effect of posteriorstabilized and cruciate-retaining implants on three-dimensional kinematic characteristics after total knee arthroplasty. Jt Dis Relat Surg 2025;36(1):3-14. doi: 10.52312/jdrs.2024.1836.

Is responsible for designing the research program, determining the method and process of the experiment, collecting and recording the experimental data, and ensuring the accuracy and integrity of the data: C.G.; Participated in the processing and analysis of the data and explained and discussed the results. Responsible for the review and analysis of relevant literature, and determining the theoretical basis and background of the research: X.L.; Participated in the statistical analysis of the experimental data and was responsible for interpreting the relevant results of the data: H.L., B.Y.; Participated in the review and editing of the article put forward valuable revision opinions and suggestions, and provided financial support for the experiment: M.F.; Participated in the operation and management of the experiment, assisted in the process of data collection and processing, and explained and discussed the experimental data, which provided important support for the conclusion of the paper: W.L. All authors read and approved the final manuscript.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

This study was supported by three research grants from the National Nature Science Foundation of China (81974343), the Nature Science Foundation of Guangdong Province (2020A1515010394), and the Nature Science Foundation of Guangdong Province (2023A1515012682).

We would like to express our gratitude to YuRong Mao for her invaluable support in operating the gait analyzer, data acquisition, and technical assistance for gait analysis. Dr Suiwen He provided me with valuable clinical experience and guidance in osteoarthritis. Special thanks to Weiwen Zhu and Zhijian Yang for their guidance and expertise in experiment design and planning. Finally, I am grateful to Sun Yat-sen University for providing an excellent learning platform, abundant resources, and an open academic environment.

The data that support the findings of this study are available from the corresponding author upon reasonable request.