Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2024; 15(2): 118-128
Published online Feb 18, 2024. doi: 10.5312/wjo.v15.i2.118
Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty
Jonathan L Katzman, Akram A Habibi, Muhammad A Haider, Casey Cardillo, Ivan Fernandez-Madrid, Morteza Meftah, Ran Schwarzkopf
Jonathan L Katzman, Akram A Habibi, Muhammad A Haider, Casey Cardillo, Ivan Fernandez-Madrid, Morteza Meftah, Ran Schwarzkopf, Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
Author contributions: All authors contributed to the study conception and design; Material preparation, data collection and analysis were performed by Katzman JL, Habibi AA, Haider MA, Cardillo C, Fernandez-Madrid I, Meftah M, Schwarzkopf R; The first draft of the manuscript was written by Katzman JL and Habibi AA; Haider MA, Cardillo C, Fernandez-Madrid I, Meftah M, and Schwarzkopf R wrote, reviewed, and revised parts of the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the NYU Langone Institutional Review Board, No. i17-01223.
Informed consent statement: Waiver of informed consent.
Conflict-of-interest statement: Morteza Meftah reports financial relationships with multiple companies including CAIRA Surgical (Stock or stock Options), Conformis (Paid consultant), Constance (Stock or stock Options), Innomed (IP royalties), Intellijoint (Paid consultant) and involvement with the following organizations ISTA (Board or committee member) and Orthopedics (Editorial or governing board). Ran Schwarzkopf discloses financial relationships with Gauss Surgical (Stock or stock Options), Intellijoint (Paid consultant; Stock or stock Options), PSI (Stock or stock Options), Smith & Nephew (IP royalties; Paid consultant; Research support), and Zimmer (Paid consultant) and oganizational associations with AAOS (Board or committee member), American Association of Hip and Knee Surgeons (Board or committee member), Arthroplasty Today (Editorial or governing board), and Journal of Arthroplasty (Editorial or governing board). The remaining authors, Jonathan L. Katzman, Akram A. Habibi, Muhammad A. Haider, Casey Cardillo, and Ivan Fernandez-Madrid, have nothing to disclose.
Data sharing statement: The data presented in this retrospective study were obtained following approval from the Institutional Review Board (IRB) (i17-01223) which granted permission for the use of anonymized patient information without individual consent. The retrospective nature of this study involved the analysis of de-identified retrospective data, ensuring anonymity and minimizing the risk of identification. As such, no explicit consent from each patient was obtained due to the retrospective design and the anonymization process. The IRB approval ensures compliance with ethical guidelines and regulations regarding data use and protection. For data sharing purposes, the presented data, while anonymized, are available upon request to qualified researchers, subject to appropriate ethical approvals and data sharing agreements.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ran Schwarzkopf, MD, MSc, Professor, Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Suite 1402, New York, NY 10010, United States. ran.schwarzkopf@nyulangone.org
Received: October 13, 2023
Peer-review started: October 13, 2023
First decision: December 7, 2023
Revised: December 15, 2023
Accepted: January 9, 2024
Article in press: January 9, 2024
Published online: February 18, 2024
Abstract
BACKGROUND

Advances in implant material and design have allowed for improvements in total knee arthroplasty (TKA) outcomes. A cruciate retaining (CR) TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament. Limited research exists that has examined clinical outcomes or patient reported outcome measures (PROMs) of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant. It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.

AIM

To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.

METHODS

A retrospective, multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System (JOURNEY™ II CR; Smith and Nephew, Inc., Memphis, TN) at an urban, academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon. Patient demographics, surgical information, clinical outcomes, and PROMs data were collected via query of electronic medical records. The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and Patient-Reported Outcomes Measurement Information System (PROMIS®) scores. The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.

RESULTS

Of the 255 patients, 65.5% were female, 43.8% were White, and patients had an average age of 60.6 years. Primary osteoarthritis (96.9%) was the most common primary diagnosis. The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home (92.5%). There were 18 emergency department (ED) visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%, including a 2.4% orthopedic-related ED visit rate and a 4.7% non-orthopedic-related ED visit rate. There were three (1.2%) hospital readmissions within 90 d postoperatively. With a mean time to latest follow-up of 3.3 years, four patients (1.6%) required revision, two for arthrofibrosis, one for aseptic femoral loosening, and one for peri-prosthetic joint infection. There were significant improvements in KOOS JR, PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Mobility, and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.

CONCLUSION

The evaluated implant is an effective, novel design offering excellent outcomes and low complication rates. At a mean follow up of 3.3 years, four patients required revisions, three aseptic and one septic, resulting in an overall implant survival rate of 98.4% and an aseptic survival rate of 98.8%. The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.

Keywords: Total knee arthroplasty, Cruciate retaining, Kinematic design, Survivorship, Bearing material, Prosthetic design, Clinical outcomes, Patient-reported outcome measures

Core Tip: This study aimed to assess mid-term clinical and patient-reported outcomes of 255 total knee arthroplasties (TKAs) using a novel, kinematically-designed cruciate retaining total knee arthroplasty implant. With a mean time to follow-up of 3.3 years, there was a high implant survival rate of 98.4%. Four patients (1.6%) required a revision TKA surgery, including three (1.2%) revised for aseptic indications. Patients who received the kinematically-designed cruciate retaining TKA showed significant improvements in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Intensity, PROMIS Pain Interference, PROMIS Mobility, and PROMIS Physical Health.