Long-Term Follow-up of Dynamic Balance, Pain and Functional Performance in Cruciate Retaining and Posterior Stabilized Total Knee Arthroplasty
Background: With the perceived pain and poor
function experienced following knee arthroplasty, patients usually
feel un-satisfied. Yet, a controversy still persists on the appropriate
operative technique that doesn’t affect proprioception much.
Purpose: This study compared the effects of Cruciate Retaining
(CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA on
dynamic balance, pain and functional performance following
rehabilitation.
Methods: Thirty patients with CRTKA (group I), thirty with
PSTKA (group II) and fifteen indicated for arthroplasty but weren’t
operated on yet (group III) participated in the study. The mean age
was 54.53±3.44, 55.13±3.48 and 55.33±2.32 years and BMI
35.7±3.03, 35.7±1.99 and 35.73±1.03 kg/m2 for groups I, II and III
respectively. The Berg Balance Scale (BBS), WOMAC pain subscale
and Timed Up-and-Go (TUG) and Stair-Climbing (SC) tests were
used for assessment. Assessments were conducted four weeks preand
post-operatively, three, six and twelve months post-operatively
with the control group being assessed at the same time intervals. The
post-operative rehabilitation involved hospitalization (1st week),
home-based (2nd-4th weeks), and outpatient clinic (5th-12th weeks)
programs, follow-up to all groups for twelve months.
Results: The Mixed design MANOVA revealed that group I had
significantly lower pain scores and SC time compared with group II
three, six and twelve months post-operatively. Moreover, the BBS
scores increased significantly and the pain scores and TUG and SC
time decreased significantly six months post-operatively compared
with four weeks pre- and post-operatively and three months postoperatively
in groups I and II with the opposite being true four weeks
post-operatively. But no significant differences in BBS scores, pain
scores and TUG and SC time between six and twelve months postoperatively
in groups I and II.
Interpretation/Conclusion: CRTKA is preferable to PSTKA,
possibly due to the preserved human proprioceptors in the un-excised
PCL.
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osteoarthritis and the genesis of pain,” Med. Clin. North Am, vol. 93, no.
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patients with osteoarthritis of the hip or knee: a systematic review,”
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pp. 1489-1496, Nov. 2006.
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[7] D. S. Rooks, J. Huang, B. E. Bierbaum, S. A. Bolus, J. Rubano, et al.,
“Effect of preoperative exercise on measures of functional status in men
and women undergoing total hip and knee arthroplasty,” Arthitis Rheum,
vol. 55, no. 5, pp. 700-708, Oct. 2006.
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“Does arthroplasty type influence knee joint proprioception? A
longitudinal prospective study comparing total and unicompartmental
arthroplasty,” Knee, vol. 14, no. 3, pp. 212-217, Jun. 2007.
[9] G. S. Gill, and A. B. Joshi, “Long-term results of cemented, posterior
cruciate ligament-retaining total knee arthroplasty in osteoarthritis,” Am.
J. Knee Surg, vol. 14, no. 4, pp. 209-214, Fall 2001.
[10] A. Konig, M. Walther, S. Kirschner, and F. Gohlke, “Balance sheets of
knee and functional scores 5 years after total knee arthroplasty for
osteoarthritis: a source for patient information,” J. Arthroplasty, vol. 15,
no. 3, pp. 289-294, Apr. 2000.
[11] V. A. Brander, S. D. Stulberg, A. D. Adams, R. N. Harden, S. Bruehl, et
al.,, “Predicting total knee replacement pain. A prospective,
observational study,” Clin. Orthop. Rel. Res, no. 416, pp. 27-36, Nov.
2003.
[12] R. Dickstein, Y. Heffes, E. I. Shabtai, and E. Markowitz, “Total knee
arthroplasty in the elderly: patients’ self-appraisal 6 and 12 months
postoperatively,” Gerontology, vol. 44, no. 4, pp. 204-210, 1998.
[13] C. A. Jones, D. C. Voaklander, D. W. Johnston, and M. E. Suarez-
Almazor, “Health related quality of life outcomes after total hip and
knee arthroplasties in a community based population,” J. Rheumatol,
vol. 27, no. 7, pp. 1745-1752, Jul. 2000.
[14] R. B. Bourne, R. S. Laskin, and J. S. Guerin, “Ten-year results of the
first 100 Genesis II total knee replacement procedures,” Orthopedics,
vol. 30, Suppl. no., 8, pp. 83-85, Aug. 2007.
[15] M. F. Brassard, J. N. Insall, G. R. Scuderi, and W. Colizza, “Does
modularity affect clinical success: a comparison with a minimum 10-
year follow-up,” Clin. Orthop. Relat. Res, no. 388, pp. 26-32, Jul. 2001.
[16] M. A. Ritter, M. E. Berend, J. B. Meding, E. M. Keating, P. M. Faris, et
al., “Long-term follow up of anatomic graduated components posterior
cruciate-retaining total knee replacement,” Clin. Orthop. Rel. Res, no.
388, pp. 51-57, Jul. 2001.
[17] M. A. Ritter, J. D. Lutgring, K. E. Davis, P. M. Faris, and M. E. Berend,
“Total knee arthroplasty effectiveness in patients 55 years old and
younger: osteoarthritis vs. rheumatoid arthritis,” Knee, vol. 14, no. 1, pp.
9-11, Jan. 2007.
[18] S. Matsuda, H. Miura, R. Nagamine, K. Urabe, T. Matsunobu, et al.,
“Knee stability in posterior cruciate ligament retaining total knee
arthroplasty,” Clin. Orthop. Rel. Res, no. 366, pp. 169-173, Sep. 1999.
[19] J. I. Sorger, D. Federie, P. G. Kirk, E. Grood, J. Cochran, et al., “The
posterior cruciate ligament in total knee arthroplasty,” J. Arthroplasty,
vol. 12, no. 8, pp. 869-879, Dec. 1997.
[20] S. Yoshiya, N. Matsui, R. D. Komistek, D. A. Dennis, M. Mahfouz, et
al., “In vivo kinematic comparison of posterior-cruciate-retaining and
posterior stabilized total knee arthroplasties under passive and weightbearing
conditions,” J. Arthroplasty, vol. 20, no. 6, pp. 777-783, Sep.
2005.
[21] S. Fantozzi, F. Catani, A. Ensini, A. Leardini, and S. Giannini, ‘Femoral
rollback of cruciate-retaining and posterior-stabilized total knee
replacements: in vivo fluoroscopic analysis during activities of daily
living,” J. Orthop. Res, vol. 24, no. 12, pp. 2222-2229, Dec. 2006.
[22] R. Nabeyama, S. Matsuda , H. Miura , T. Kawano, R. Nagamine, et al.,
“Changes in anteroposterior stability following total knee arthroplasty,”
J. Orthop. Sci, vol. 8, no. 4, pp. 526-531, 2003.
[23] S. Maruyama,S. Yoshiya, N. Matsui, R. Kuroda, and M. Kurosaka,
“Functional comparison of posterior cruciate retaining versus posterior
stabilized total knee arthroplasty,” J. Arthroplasty, vol. 19, no. 3, pp.
349-353, Apr. 2004.
[24] M. Arabori, N. Matsui, R. Kuroda, K. Mizuno, M. Doita, et al.,
“Posterior condylar offset and flexion in posterior cruciate-retaining and
posterior stabilized TKA,” J. Orthop. Sci, vol. 13, no. 1, pp. 46-50, Jan.
2008.
[25] R. J. Sierra, and D. J. Berry, “Surgical technique differences between
posterior-substituting and cruciate-retaining total knee arthroplasty”, J.
Arthroplasty, vol. 23, Suppl. 7, pp. 20-23, Oct. 2008.
[26] D. S. Barrett, A. G. Cobb, and G. Bentley, “Joint proprioception in
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@article{"International Journal of Medical, Medicine and Health Sciences:69049", author = "Ahmed R. Z. Baghdadi and Mona H. Gamal Eldein", title = "Long-Term Follow-up of Dynamic Balance, Pain and Functional Performance in Cruciate Retaining and Posterior Stabilized Total Knee Arthroplasty", abstract = "Background: With the perceived pain and poor
function experienced following knee arthroplasty, patients usually
feel un-satisfied. Yet, a controversy still persists on the appropriate
operative technique that doesn’t affect proprioception much.
Purpose: This study compared the effects of Cruciate Retaining
(CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA on
dynamic balance, pain and functional performance following
rehabilitation.
Methods: Thirty patients with CRTKA (group I), thirty with
PSTKA (group II) and fifteen indicated for arthroplasty but weren’t
operated on yet (group III) participated in the study. The mean age
was 54.53±3.44, 55.13±3.48 and 55.33±2.32 years and BMI
35.7±3.03, 35.7±1.99 and 35.73±1.03 kg/m2 for groups I, II and III
respectively. The Berg Balance Scale (BBS), WOMAC pain subscale
and Timed Up-and-Go (TUG) and Stair-Climbing (SC) tests were
used for assessment. Assessments were conducted four weeks preand
post-operatively, three, six and twelve months post-operatively
with the control group being assessed at the same time intervals. The
post-operative rehabilitation involved hospitalization (1st week),
home-based (2nd-4th weeks), and outpatient clinic (5th-12th weeks)
programs, follow-up to all groups for twelve months.
Results: The Mixed design MANOVA revealed that group I had
significantly lower pain scores and SC time compared with group II
three, six and twelve months post-operatively. Moreover, the BBS
scores increased significantly and the pain scores and TUG and SC
time decreased significantly six months post-operatively compared
with four weeks pre- and post-operatively and three months postoperatively
in groups I and II with the opposite being true four weeks
post-operatively. But no significant differences in BBS scores, pain
scores and TUG and SC time between six and twelve months postoperatively
in groups I and II.
Interpretation/Conclusion: CRTKA is preferable to PSTKA,
possibly due to the preserved human proprioceptors in the un-excised
PCL.
", keywords = "Dynamic Balance, Functional Performance, Knee
Arthroplasty, Long-Term.", volume = "9", number = "2", pages = "129-6", }
