Ultra-Congruent Versus Cruciate-Retaining Inserts in Bilateral Simultaneous Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.
Kushagra Pathak, Sahil Batra, Arpit Sahu et al.
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In 30 seconds
This prospective, randomized, double-blinded trial compared ultra-congruent (UC) and cruciate-retaining (CR) inserts in 53 patients undergoing bilateral simultaneous total knee arthroplasty for end-stage osteoarthritis. Each patient received one insert type in each knee. UC knees had significantly better Forgotten Joint Scores at every postoperative assessment; the largest difference was at one year (UC: 73.2 ± 6.0 versus CR: 67.5 ± 16.6; P = 0.007). Other clinical, radiological, and gait-related measures did not differ significantly. The patient-reported advantage persisted through two-year follow-up but was not reflected in objective measures.
Key findings
- Forgotten Joint Scores were significantly higher with UC inserts at all postoperative intervals (P < 0.05).
- At one year, FJS was 73.2 ± 6.0 with UC versus 67.5 ± 16.6 with CR (P = 0.007).
- No statistically significant between-group differences were found in other clinical, radiological, or gait parameters.
Why it matters
The findings suggest that insert design may influence patients’ awareness of the replaced joint even when measured clinical and objective outcomes are similar. Patient-reported outcomes therefore provide information not captured by stability testing, gait analysis, or other reported measures. The results also inform comparison of a posterior cruciate ligament-sacrificing design with a cruciate-retaining option, while the absence of objective differences tempers interpretation of the subjective advantage.
What to keep in mind
The trial involved 53 patients treated by a single surgeon, and the reported patient-perceived advantage was not supported by differences in objective parameters.