Posterior cruciate-retaining versus posterior stabilising prostheses for primary total knee arthroplasty in treating osteoarthritis: A systematic review and meta-analysis of randomised controlled trials

Background

Total knee replacements (TKRs) are successful operations that utilities several operative techniques including cruciate retaining (CR) and posterior stabilising (PS) prostheses. To date, neither approach has proved superior. Techniques and implants are under constant evolution and new trials are published. The purpose of this meta-analysis is to determine the current risks and benefits of these two approaches so that an up-to-date clinical recommendation can be given as to which approach if any is superior.

Methods

We searched PubMed, Cochrane, Embase, Scopus, EBCSO, and Google Scholar. Risk of bias was assessed based on the Cochrane risk of bias criteria. Meta-analysisusing the random effects model was performed by the STATA software and results were displayed on forest plots. Sensitivity analysis was performed for possible causes of heterogeneity.

Results

From 1164 studies, 15 eligible trials were included. Meta-analysis showed that the CR approach had significantly lower Range of Motion and HSS scores. There was no significant difference in KSS, OKS, VAS, or WOMAC scores. Blood loss was significantly less in the CR group. However, there was no significant difference in total complications or revisions. Sensitivity analysis did not reveal any differences in the results.

Conclusion

Despite inherent limitations, this updated meta-analysis suggests that both CR and PS approaches continue to be equivocal in terms of clinical outcomes. Both patients and surgeons can be confident in selecting either approach.

Level of evidence

Level I.

Systematic review registration

the protocol of this systematic review has been registered on PROSPERO. Registration number: CRD42023391435.