Cruciate-retaining versus posterior-stabilized total knee arthroplasty: The argument for posterior cruciate substitution

Posterior cruciate-retaining and posterior-stabilized total knee designs have been competing with each other since the early 1980s. Preservation of the posterior cruciate ligament is said to produce a knee with a more natural feeling for the patient and with better function on stair climbing. The posterior-stabilized knee is said to be an easier knee surgery to perform, and the results are said to be the same or better than the cruciate-retaining designs with better range of motion. The arguments for each design are both convincing. In the United States, the number of posterior-stabilized knee surgeries continues to increase versus the posterior-retaining designs. The majority of the total knee arthroplasties are performed by surgeons who implant 15-20 per year. The publications concerning the two designs are written by surgeons who perform hundreds of implants each year. The surgeon performing the operation must call upon his own experience and not that of the authors who write the articles. The surgeon must feel comfortable with the implant design and the technique. If the results are guile similar, the posterior-stabilized knee surgery is easier to perform and duplicate from case to case. The posterior-stabilized knee continues to gain in popularity and probably will continue to do so over the next few years.