Tension controlled ligament balanced total knee arthroplasty: 5-year results of a soft tissue orientated surgical technique

Introduction

Posterior cruciate ligament (PCL)-retaining prostheses give good outcomes and are commonly used. This retrospective study investigated outcomes from total knee arthroplasty (TKA) using the ligament balancing technique to implant a PCL-retaining knee prosthesis (balanSys™ knee system) with either a mobile or a fixed bearing polyethylene inlay.

Materials and methods

A retrospective study was performed on patients treated with TKA at one surgical centre between 1997 and 2001. In this period 182 surgeries were performed. Clinical assessments of the implant used the Knee Society Score (KSS). Subjective assessments used visual analogue scale (VAS) for pain and patient satisfaction. The Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness and function of the knee. Radiographic analysis was performed to determine frontal and sagittal alignment and loosening.

Results

A total of 109 knee implants in 95 patients (26 men; 69 women) were followed up. Seventy-three cases were not available for follow-up due to bad health or death of the patient; 74% of 109 reviewed implants had fixed bearings and 26% had mobile bearings. The mean age at surgery was 72.9 ± 7.35 years (range 54.7–92.4). The mean KSS was 160 ± 28.3 points. The KSS was greater for men and was significantly reduced when another disease was present. The type of bearing, surgical approach, and pre-operative alignment for patients affected by varus or valgus gonarthrosis had no significant impact on KSS and ROM. According to VAS the mean scores for pain and satisfaction were 1.48 (0 = no pain) and 9.2 (10 = very satisfied), respectively. The WOMAC mean scores for pain (87.0), stiffness (82.3) and function (78.6) were high (best outcome score of 100). There were no revisions due to aseptic loosening or wear.

Conclusion

Total knee arthroplasty performed with a PCL-retaining prosthesis implanted by using a soft tissue oriented surgical technique is a safe procedure and was associated with good results. So far, there were few complications and no need for revision due to aseptic loosening. In addition, most of the patients reported little pain and were satisfied with the outcome. These good outcomes are comparable with other studies reporting on PCL-retaining prostheses.