Can pain be improved with retention of the posterior cruciate ligament during total knee arthroplasty?

• Published in: European journal of orthopaedic surgery & traumatology 2023-12, Vol.33 (8), p.3395-3401
• Main Authors: Fiedler, Benjamin, Bieganowski, Thomas, Anil, Utkarsh, Lin, Charles C., Habibi, Akram A., Schwarzkopf, Ran
• Format: Article
• Language: English
• Subjects: Joint replacement surgery; Medicine; Medicine & Public Health; Narcotics; Original Article; Pain; Surgical Orthopedics; Traumatic Surgery
• ISSN: 1432-1068; 1633-8065; 1432-1068
• DOI: 10.1007/s00590-023-03562-6

Purpose The purpose of the current study was to determine if differences exist between cruciate-retaining (CR) and posterior-stabilized (PS) implant articulations for total knee arthroplasty (TKA) with regards to early post-operative pain. Methods We retrospectively reviewed patients who underwent primary TKA, with the same TKA implant design, at our institution between January 2018 and July 2021. Patients were stratified based on whether they received a CR or non-constrained PS (PSnC) articulation and propensity score matched in a 1:1 ratio. A sub-analysis matching patient who received a constrained PS implant (PSC) to those undergoing CR TKA and PSnC TKA was also carried out. Opioid dosages were converted to morphine milligram equivalents (MME). Results 616 patients after CR TKA were matched 1:1 to 616 patients with a PSnC implant. There were no significant differences between demographic variables. There were no statistically significant differences in opioid usage measured by MME on post-operative day (POD) 0 ( p  = 0.171), POD1 ( p  = 0.839), POD2 ( p  = 0.307), or POD3 ( p  = 0.138); VAS pain scores ( p  = 0.175); or 90-day readmission rate for pain ( p  = 0.654). A sub-analysis of CR versus PSC TKA demonstrated no significant differences in opioid usage on POD0 ( p  = 0.765), POD1 ( p  = 0.747), POD2 ( p  = 0.564), POD3 ( p  = 0.309); VAS pain scores ( p  = 0.293); and 90-day readmission rate for pain ( p  > 0.9). Conclusion Our analysis demonstrated no significant difference in post-operative VAS pain scores and MME usage based on implant. The results suggest that neither the type of articulation or constraint used for primary TKA has a significant impact on immediate post-operative pain and opioid consumption. Level III Evidence Retrospective Cohort Study.