Comparison of Posterior Cruciate-Retaining and High-Flexion Cruciate-Retaining Total Knee Arthroplasty Design

High-flexion prostheses have been developed to achieve deep flexion after total knee arthroplasty. The purpose of this study is to compare standard NexGen (CR, cruciate-retaining) and high-flexion NexGen (CR-flex) total knee prostheses in terms of range of motion, clinical and radiologic outcomes, rates of complications, and survivorship in long-term follow-up.

From January 2000 to December 2008, 423 consecutive knees underwent total knee arthroplasty using standard CR or CR-flex prostheses. Fifty-three patients were lost to follow-up or declined to participate and 54 died, leaving 290 knees. The minimum duration of follow-up was 8 years (mean 10.1 years). Physical examination and knee scoring of patients were assessed preoperatively, at 6 months and 1 year after surgery, and annually thereafter. Supine anteroposterior and lateral radiographs and standing anteroposterior hip-to-ankle radiographs were obtained preoperatively and at each follow-up.

Mean postoperative range of motions in the standard CR group and the CR-flex group were similar, showing no significant difference between the 2 groups (P = .853). At the time of the final follow-up, mean total Hospital for Special Surgery scores were similar between the 2 groups (P = .118). Mean Knee Society pain (P = .325) and function scores (P = .659) were also comparable between the 2 groups. Western Ontario and McMaster Universities Osteoarthritis Index score showed no intergroup difference either (P = .586). The mean hip-knee-ankle angle at the final follow-up was approximately the same (P = .940). Mean coronal angles of femoral and tibial component at final follow-up were also similar (P = .211 and P = .764, respectively). The prevalence of the radiolucent line was 0.6% in the standard CR group and 0.9% in the CR-flex group. Estimated survival rate according to Kaplan-Meier survival analysis was 97.2% in the standard CR group and 95.6% in the CR-flex group at mean follow-up of 10.1 years.

This study suggests that excellent clinical and radiographic outcomes could be achieved with both standard and high-flexion CR total knee designs. High-flexion CR prosthesis did not show any advantages over the standard design.