Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty

Background: In an effort to optimize clinical outcomes and enhance stability, ultracongruent bearings have been increasingly used in primary total knee arthroplasty (TKA). The importance of the posterior cruciate ligament (PCL) and optimal sagittal tibial baseplate position in ultracongruent bearing...

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Autores principales:	Joseph A. Madden, BS, Payton K. Arnold, MS, Leonard T. Buller, MD, Evan R. Deckard, BSE, R. Michael Meneghini, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Total knee arthroplasty Patient-reported outcomes Conforming polyethylene tibial bearing Posterior cruciate ligament Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/5a97b4d98ff7461daa786e8725ea038b
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spelling	oai:doaj.org-article:5a97b4d98ff7461daa786e8725ea038b2021-11-14T04:34:04ZTibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty2352-344110.1016/j.artd.2021.08.014https://doaj.org/article/5a97b4d98ff7461daa786e8725ea038b2021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352344121001552https://doaj.org/toc/2352-3441Background: In an effort to optimize clinical outcomes and enhance stability, ultracongruent bearings have been increasingly used in primary total knee arthroplasty (TKA). The importance of the posterior cruciate ligament (PCL) and optimal sagittal tibial baseplate position in ultracongruent bearing TKA remains unknown. This study sought to determine whether these modifiable, surgical-technique-dependent variables meaningfully impact patient-reported outcome measures. Methods: A total of 759 primary TKAs of the same dual-pivot design performed using a consistent surgical technique between January 2016 and April 2019 were retrospectively reviewed. PCL status was recorded, and anteroposterior (AP) tibial baseplate position and posterior tibial slope were measured by two independent blinded raters. Patient-reported outcomes related to pain, function, satisfaction, and activity level were analyzed in relationship to PCL status, posterior tibial slope, and AP tibial baseplate position, in addition to other pertinent covariates. Results: Median age and body mass index of the cohort were 68.3 years and 33.4 kg/m2, respectively, with 73% being female. In multivariate analysis, partial or full release of the PCL was predictive of a knee “always” feeling normal (odds ratio 1.42, P = .041). Furthermore, tibial baseplate position closer to the middle of the tibia was associated with greater improvements in pain with level walking, pain while climbing stairs, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores (P ≤ .079). Conclusion: In congruent dual-pivot bearing TKA, partially or fully releasing the PCL and AP tibial baseplate position closer to the middle of the tibia may provide greater improvement in pain and function scores at minimum 1-year follow-up.Joseph A. Madden, BSPayton K. Arnold, MSLeonard T. Buller, MDEvan R. Deckard, BSER. Michael Meneghini, MDElsevierarticleTotal knee arthroplastyPatient-reported outcomesConforming polyethylene tibial bearingPosterior cruciate ligamentOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 178-186 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Total knee arthroplasty Patient-reported outcomes Conforming polyethylene tibial bearing Posterior cruciate ligament Orthopedic surgery RD701-811
spellingShingle	Total knee arthroplasty Patient-reported outcomes Conforming polyethylene tibial bearing Posterior cruciate ligament Orthopedic surgery RD701-811 Joseph A. Madden, BS Payton K. Arnold, MS Leonard T. Buller, MD Evan R. Deckard, BSE R. Michael Meneghini, MD Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
description	Background: In an effort to optimize clinical outcomes and enhance stability, ultracongruent bearings have been increasingly used in primary total knee arthroplasty (TKA). The importance of the posterior cruciate ligament (PCL) and optimal sagittal tibial baseplate position in ultracongruent bearing TKA remains unknown. This study sought to determine whether these modifiable, surgical-technique-dependent variables meaningfully impact patient-reported outcome measures. Methods: A total of 759 primary TKAs of the same dual-pivot design performed using a consistent surgical technique between January 2016 and April 2019 were retrospectively reviewed. PCL status was recorded, and anteroposterior (AP) tibial baseplate position and posterior tibial slope were measured by two independent blinded raters. Patient-reported outcomes related to pain, function, satisfaction, and activity level were analyzed in relationship to PCL status, posterior tibial slope, and AP tibial baseplate position, in addition to other pertinent covariates. Results: Median age and body mass index of the cohort were 68.3 years and 33.4 kg/m2, respectively, with 73% being female. In multivariate analysis, partial or full release of the PCL was predictive of a knee “always” feeling normal (odds ratio 1.42, P = .041). Furthermore, tibial baseplate position closer to the middle of the tibia was associated with greater improvements in pain with level walking, pain while climbing stairs, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores (P ≤ .079). Conclusion: In congruent dual-pivot bearing TKA, partially or fully releasing the PCL and AP tibial baseplate position closer to the middle of the tibia may provide greater improvement in pain and function scores at minimum 1-year follow-up.
format	article
author	Joseph A. Madden, BS Payton K. Arnold, MS Leonard T. Buller, MD Evan R. Deckard, BSE R. Michael Meneghini, MD
author_facet	Joseph A. Madden, BS Payton K. Arnold, MS Leonard T. Buller, MD Evan R. Deckard, BSE R. Michael Meneghini, MD
author_sort	Joseph A. Madden, BS
title	Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
title_short	Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
title_full	Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
title_fullStr	Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
title_full_unstemmed	Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
title_sort	tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/5a97b4d98ff7461daa786e8725ea038b
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Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty

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