Posterior-stabilized inserts are preferable to cruciate-substituting ultracongruent inserts due to more favourable kinematics and stability

Abstract

PurposeIt is unknown whether the conforming superiority of ultracongruent (UC) inserts over posterior stabilized (PS) inserts, due to an increased anterior lip for prevention of anterior displacement of the condyles during knee flexion, leads to better knee scores or greater knee stability in arthroplasty patients. This meta-analysis compared clinical outcomes, intraoperative kinematics, sagittal stability, and range of motion (ROM) between groups with either UC or PS inserts in primary total knee arthroplasty (TKA).MethodsStudies that recorded clinical outcomes, intraoperative kinematics, sagittal stability, and ROM in patients who underwent primary TKA with UC or PS inserts were included in the meta-analysis. Subgroup analyses based on differences in flexion angles were performed for intraoperative kinematics.ResultsThirteen studies met the criteria for inclusion in the meta-analysis. The UC and PS insert groups reported similar pain scores (95% CI -0.15 to 0.16; n.s.) and function scores (95% CI -0.30 to 0.14; n.s.). In contrast, femoral rotation during flexion (95% CI -0.06 to 6.35; p=0.05), posterior femoral translation during flexion (95% CI -2.74 to -0.15; p=0.03), tibial sagittal laxity at 90 degrees (95% CI 2.91 to 7.72; p<0.0001), and ROM (95% CI -4.84 to -1.53; p=0.0002) differed significantly between the groups. Subgroup analyses revealed that the pooled data for femoral rotation were significantly different between groups: 60 degrees, 4.09 (p<0.00001); 90 degrees, 7.94 (p<0.00001); and 120 degrees, 8.16 (p<0.00001). Furthermore, pooled data for posterior femoral translation were significantly different between groups: 90 degrees, -3.70 (p<0.00001); and 120 degrees, -3.96 (p<0.00001).ConclusionsThere were no significant differences in clinical outcomes between the groups with UC and PS inserts. However, the UC insert group showed significantly greater external femoral rotation, less posterior femoral translation, greater tibial laxity in the sagittal plane, and less ROM than the PS insert group. Based on the results of the current meta-analysis, in substituting the PCL, PS inserts are preferable to UC inserts due to more favourable kinematics and stability, even though both inserts have equivalent clinical outcomes.Level of evidenceTherapeutic study, Level II.