Second-generation bi-cruciate stabilized total knee system has a lower reoperation and revision rate than its predecessor

Arch Orthop Trauma Surg. 2018 Nov;138(11):1591-1599. doi: 10.1007/s00402-018-3019-5. Epub 2018 Aug 25.


Introduction: Total knee arthroplasty (TKA) can provide pain relief and good long-term results. However, nearly 30% of post-surgical patients are unsatisfied due to persistent pain and functional deficits. A second-generation bi-cruciate stabilized TKA device has a post-cam mechanism with an asymmetric femoral component, a polyethylene insert, and a medially concave and laterally convex shape. The device is designed to provide guided motion, and thus improve knee kinematics by more closely approximating a normal knee. The aim of this study was to evaluate early complication and revision rates of the second-generation device and to compare its clinical performance to the first-generation device.

Materials and methods: In this retrospective, longitudinal, non-concurrent cohort study, 140 TKAs were performed using the second-generation device on 131 patients from 2012 to 2016, and 155 TKAs were performed using the first-generation device on 138 patients from 2009 to 2012. Primary outcomes were occurrence of revisions and reoperations.

Results: There were 31 reoperations [3.21 per 100 observed component years (OCY)] in 22 (2.28 per 100 OCY) TKAs in the first-generation device cohort compared to five reoperations (1.92 per 100 OCY) in four TKAs (1.54 per 100 OCY) in the second-generation device cohort. The adjusted hazard ratio (HR) was 3.50 (P = 0.0254). There were 21 revisions (2.17 per 100 OCY) in 16 (1.66 per 100 OCY) TKAs in the first-generation device cohort, compared to only three revisions (1.15 per 100 OCY) in two TKAs (0.77 per 100 OCY) in the second-generation device cohort. The adjusted HR was 4.16 (P = 0.0693).

Conclusion: The improved design of the second-generation device appears to be associated with a lower risk of reoperation and revision compared to that of the first-generation device.

Level of evidence: III.

Keywords: Bi-cruciate stabilized; Complications; Guided motion; Reoperations; Revisions; Total knee arthroplasty.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / adverse effects
  • Arthroplasty, Replacement, Knee / instrumentation*
  • Arthroplasty, Replacement, Knee / methods
  • Cohort Studies
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Knee Joint / surgery*
  • Knee Prosthesis / adverse effects*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Prosthesis Failure / adverse effects*
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Risk