title: Comparison of long-term clinical outcomes after bilateral mobile-bearing total knee arthroplasties using PCL-retaining and PCL-substituting implants in the same patients.
abstract: OBJECTIVE
  Whether the posterior cruciate ligament (PCL) should be retained or substituted in total knee arthroplasty (TKA) remains an issue of concern. The purpose of this study was to perform within-patient comparisons of mid- and long-term clinical outcomes after mobile-bearing TKA using PCL-retaining (PCLR) and PCL-substituting (PCLS) implant designs.
  
  
  METHODS
  Clinical outcomes were assessed in thirty-eight patients (76 knees) who underwent bilateral scheduled staged TKA with a PCLR design on one side and a PCLS design on the other. Median follow-up periods were 118 months (range 60-211) and 114 months (62-198) in knees with PCLR and PCLS implants, respectively. The preoperative diagnosis for all patients was osteoarthritis. The postoperative clinical results of mobile-bearing TKAs using PCLR and PCLS implant designs were evaluated.
  
  
  RESULTS
  The postoperative Hospital for Special Surgery and the new Knee Society Knee Scoring System scores revealed no differences between PCLR and PCLS implant designs. Postoperative flexion and extension also did not differ between designs. Postoperative median femorotibial alignment was 4° for PCLR and 5° for PCLS implants, respectively; this difference was not significant. Six of the knees with PCLR and three of the knees with PCLS implants had radiolucent lines around the tibial prostheses; these were less than 1 mm and nonprogressive.
  
  
  CONCLUSIONS
  Clinically good results were obtained at approximately 10 years after mobile-bearing TKA using both PCLR and PCLS implant designs bilaterally in the same patients. These results provide conclusive evidence that equivalent clinical results can be obtained with either implant design.
  
  
  METHODS
  Therapeutic study, Level II.
authors.affiliation: Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan. ishii@sakitama.or.jp.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishii
authors.affiliation: Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Noguchi
authors.affiliation: Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Sato
authors.affiliation: Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Division of Information Science and Biostatistics, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Toyabe
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000601:surgery; D011184:Postoperative Period; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery
keywords: Clinical outcome; HSS score; Mobile-bearing TKA; New KSKSS; PCL- substituting design; PCL-retaining design