Evaluation of the Early Functional Outcomes Following Cruciate-Retaining Total Knee Arthroplasty: A Prospective Study

Abstract

Background: Cruciate-retaining total knee arthroplasty (CR-TKA) preserves the posterior cruciate ligament (PCL) and may provide physiological knee kinematics and satisfactory functional recovery. However, the early functional outcomes and postoperative recovery following CR-TKA remain important areas of clinical evaluation. This study was conducted to assess the early functional outcomes, pain relief, range of motion (ROM), functional recovery, and complications following CR-TKA. Methods: This prospective study was conducted in the Department of Orthopaedics at a tertiary care hospital in Rohtak, Haryana, after obtaining ethical approval and clinical trial registration. Fifteen patients undergoing primary total knee arthroplasty with an intact PCL were included. Patients with infection, bleeding disorders, neurological or vascular disorders of the lower limb, significant deformities, previous posterior cruciate ligament injury, post-traumatic or post-infectious osteoarthritis, and those requiring revision or hinged prostheses were excluded. Patients were followed clinically and radiographically at 1, 3, and 6 months postoperatively. Outcomes were assessed using range of motion (ROM), Visual Analogue Scale (VAS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR). Postoperative complications were also documented. Results: The mean age of the patients was 58.40 ± 13.02 years, with 53.3% females and 46.7% males. There was significant improvement in knee ROM from 103.67 ± 13.02° preoperatively to 117.67 ± 9.98° at 6 months (p < 0.0001). Mean VAS pain scores decreased significantly from 9.87 ± 0.35 preoperatively to 0.40 ± 0.51 at 6 months (p < 0.0001). The mean KSS improved from 36.60 ± 10.46 preoperatively to 75.40 ± 6.82 at 6 months (p < 0.0001). WOMAC total scores decreased from 63.20 ± 11.12 to 3.07 ± 1.53, while KOOS-JR-related scores also demonstrated significant improvement at 6 months (p < 0.0001). At 1 month, stiffness and superficial skin infection were reported in 13.3% of patients each. By 3 and 6 months, 86.7% of patients had no reported complications. No cases of deep vein thrombosis, pulmonary embolism, compartment syndrome, deep wound infection, or mortality were observed. Conclusion: Cruciate-retaining total knee arthroplasty was associated with significant improvements in knee range of motion, pain, functional status, and patient-reported outcomes during the first 6 months following surgery. The observed complication profile was generally favorable. Larger prospective studies with longer follow-up are required to confirm these findings and evaluate the long-term functional outcomes of CR-TKA.

Keywords: Cruciate-retaining total knee arthroplasty; Total knee arthroplasty; Posterior cruciate ligament; Knee osteoarthritis; Functional outcome; Knee Society Score; WOMAC; KOOS-JR; Pain; Range of motion.