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F. Lavoie, K. Iguer, F. Al-Shakfa

98

identical rectangular extension and flexion

gaps, similar to the original technique of

Cloutier, however the surgical flow is smoother

and operative times are comparable to other

knee arthroplasty techniques.

Clinical results

The first 100 bicruciate-retaining TKAs

performed with this implant and the revisited

technique

(Hermes 2C, Ceraver Osteal,

Roissy, France)

by the first author were

reviewed. A cohort of 100 posterior-stabilized

TKA

(Hermes PS, Ceraver Osteal, Roissy,

France)

matched for sex and height with the

bicruciate-retaining arthroplasty cohort also

performed by the first author was also reviewed

as well (Table 1). The shape of the femoral

component of the two implants is essentially

identical, other than the intercondylar portion;

both implants offer essentially no rotational

constraint in the transverse plane; finally the

surgical technique for the two cohorts is the

same, other than the preservation of the

cruciate ligaments: it is therefore reasonable

to think that this comparative study, although

far from perfect, can provide some insight on

the impact of preserving both cruciate

ligaments during TKA.

Our results confirm that bicruciate-retaining

TKA results in good clinical outcomes with

significant improvement of the two components

of the Knee Society (KS) score and of all five

components of the KOOS (Table 2). Knee

instability was not an issue for the two cohorts,

most probably because of the surgical technique

that was used. However, like Goutallier

et al.

[6], we observed a decrease in maximal knee

flexion at the last follow-up. In our series, the

2C knees lost an average of 8 degrees of flexion

compared to the pre-operative value, while the

PS knees gained an average of 5 degrees of

flexion. Also, five patients with a bicruciate-

retaining prosthesis had a mobilization of their

knee under general anesthesia compared to

none in the posterior-stabilized cohort.

Table 1: Pre-operative data for Bicruciate-retaining (2C) and Posterior-stabilized (PS) TKA cohorts.

2C

PS

p value

Number of knees

100

100

Number of patients

90

88

Male/Female

37/63

34/66

0,658

Age (range)

63 (45-83)

67 (43-85)

0,002

Weight (kg)

89,5

81,3

0,003

Height (m)

1,65

1,65

0,687

Medial HKA angle (range)

174,5 (163-191)

174,3 (153-194)

0,807

Knee flexion contracture (range)

1,3 (0-15)

2,4 (0-20)

0,051

Knee flexion (range)

127,2 (100-160)

119,8 (40-160)

0,030

KS Knee Score

48,7

44,1

0,089

KS Function Score

56,6

53,5

0,262

KOOS - Pain

33,4

35,3

0,500

KOOS - Symptom

39,1

40,6

0,613

KOOS - Activities of daily life

38,0

37,6

0,875

KOOS - Sporting activities

12,0

11,9

0,972

KOOS - Quality of life

20,6

22,3

0,560