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The Journal of Bone and Joint Surgery, Vol 70, Issue 8 1163-1173, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Results after knee replacement with a posterior cruciate-substituting prosthesis
WN Scott, M Rubinstein and G Scuderi
Department of Orthopedics, Lenox Hill Hospital, New York City.
From 1979 to 1984, eighty patients (119 knees) were arbitrarily selected
for treatment with knee arthroplasty in which a posterior
cruciate-substituting replacement was used. The average age of the
forty-nine women and thirty-one men was 66.9 years (range, twenty-two to
eighty-four years). Sixty-one right and fifty-eight left knees were
operated on, and bilateral replacement was performed in thirty-nine of the
eighty patients. The diagnosis was osteoarthritis in fifty-eight patients
(eighty-eight knees), rheumatoid arthritis in fourteen patients (twenty-two
knees), osteonecrosis in three patients (four knees), and traumatic
arthritis secondary to a fracture of the tibia or femur in five patients
(five knees). The average preoperative score on The Hospital for Special
Surgery knee-rating scale was 47.5 points, and the average range of motion
preoperatively was 88 degrees (range, 30 to 140 degrees). Of the 119 knees,
eighty-seven had a varus alignment (maximum, 35 degrees) before knee
replacement. After follow-up of two to eight years, the average score on
The Hospital for Special Surgery scale was 90 points, and the average range
of motion was 107 degrees. Of the 119 knees, 83 per cent were rated as
excellent; 15 per cent, as good; none, as fair; and 2 per cent, as poor.
Radiolucencies of one millimeter were present in 76 per cent of the knees;
of two millimeters, in 7 per cent; and of three millimeters, in 3 per cent.
No statistically significant correlation between radiolucencies and the
clinical result was found. The results in knees of patients who had
rheumatoid arthritis were not as good as those in knees of patients who had
other diagnoses (F = 11.44). Our experience suggested that the posterior
cruciate-substituting design provides more motion than do the
cruciate-sacrificing surface-replacement designs, with no deleterious
effects. The rate of infection (1.6 per cent) after these procedures, which
were carried out in a standard operating theater with vertical airflow, was
equivalent to that in other published series in which rooms with laminar
airflow were used. Patients who had a bilateral procedure did as well as
those who had a unilateral replacement, but they required approximately 3.5
more units of blood.
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