Document Title: Swanik-JBJS-Feb04.shtml
Article Title: Proprioception, Kinesthesia, and Balance After Total Knee Arthroplasty with Cruciate-Retaining and Posterior Stabilized Prostheses
Authors: C. Buz Swanik, PhD, ATC, Scott M. Lephart, PhD, ATC and Harry E. Rubash, MD
Publication: The Journal of Bone and Joint Surgery (American)
Date: February 2004
Volume 86, pages 328-334
Keywords: TKR, TKA, total knee replacement, total knee arthroplasty, cruciate-retaining, posterior stabilized prostheses

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Comments: This study shows that there is less difference than one might anticipate between cruciate-retaining and posterior stabilized types of knee prostheses. The installation of many types of knee prostheses typically includes the removal of one or both cruciate ligaments. Intuitively, however, one might except that keeping both of the cruciate ligaments would be prefereable. This study focused specifically on the effect of conserving the posterior cruciate ligament, and it found that saving the PCL did not bring a significant benefit with regards to proprioception. (If both the ACL and the PCL were conserved, then perhaps a more substantial benefit might be realized.)

Abstract

Background: The effect of total knee arthroplasty on proprioception, kinesthesia, and postural control remains controversial. It is argued that retaining the posterior cruciate ligament may help to preserve these sensorimotor functions and improve the longevity of the prosthesis and the functional outcome. We performed a prospective, randomized study to assess proprioception, kinesthesia, and balance following total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses.

Methods: Twenty patients scheduled to undergo total knee arthroplasty were randomly assigned to receive either a cruciate-retaining or a posterior stabilized prosthesis. Joint-position sense, the threshold to detect joint motion, and the subject's ability to balance on an unstable platform were assessed prior to and at least six months after the operation. Paired two-tailed t tests (with a level of significance of p < 0.05) were used to assess the effect of the arthroplasty on the preoperative measures for all subjects. Analysis of covariance was performed to identify the effects of prosthetic design.

Results: Following total knee arthroplasty, patients detected motion significantly faster and reproduced joint position with less error. The balance index also improved significantly from the preoperative to the postoperative evaluation. The group treated with the posterior stabilized prosthesis more accurately reproduced joint position when the knee was extended from a flexed position.

Conclusions: Total knee arthroplasty results in mild improvements in proprioception, kinesthesia, and balance. These changes may result from the retensioned capsuloligamentous structures and reduced pain and inflammation. Retention of the posterior cruciate ligament does not appear to significantly improve proprioception and balance compared with those functions in patients with a posterior stabilized total knee design.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

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