Cruciate Retaining Arthroplasty
Strong evidence supports no difference in outcomes or complications between posterior stabilized and posterior cruciate retaining arthroplasty designs.
Surgical Management of Osteoarthritis of the Knee
Endorsed by: The Knee Society, SOMOS, AAHKS, ACR, AGS, AANA

Rationale
Meta-analysis of included literature was unable to show a difference between the cruciate retaining and posterior stabilized designs with regard to complications, pain, function or patient reported outcomes.
 
There is one high quality prospective comparative study (Maruyama 2004) evaluating outcomes and ROM in consecutive patients having bilateral total knee arthroplasty who had one posterior stabilized (PS) implant and one posterior cruciate retaining (CR) implant. They found equivalent Knee Society Scores, but statistically improved ROM in the PS group. Another high quality study (Roh 2013) failed to show improved kinematics or improved clinical outcome with PCL retention in highly conforming mobile bearing total knee arthroplasty. A third high quality study (Cankaya 2014) investigated blood loss with CR and PS designs in a prospective randomized study of 100 patients. They found no difference in either perioperative blood loss or postoperative transfusion rates between the two types of designs.
 
A moderate quality study (Clark 2001) in patients without extreme pre-operative deformities showed no notable differences between PS and CR designs with regard to knee scores, ROM or patient reported outcomes instruments SF-12 and WOMAC.  Likewise, four other moderate quality studies (Tanzer 2002, Catani 2004, Molt 2014, Ishii 2011) showed no differences between the CR and PS designs. Tanzer 2002 controlled for surgical technique by having a single surgeon perform a similar surgical technique for each design. Catani 2004 and Molt 2014 showed no statistical difference between designs with regard to tibial migration. Ishii 2011 found no difference between designs in range of motion. 
 

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