Factors affecting anteroposterior instability following cruciate-retaining total knee arthroplasty in patients with rheumatoid arthritis

Controversy persists concerning around posterior cruciate ligament (PCL) retention in total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA). This study investigated factors affecting anteroposterior (AP) instability following cruciate-retaining (CR)-TKA. In a consecutive series of 70 knees from 52 RA patients, total displacement (TD) was measured using a KT-2000 arthrometer before and after CR-TKA under anesthesia, and changes in TD were defined as ΔTD. TD was also measured under anesthesia in 65 knees from 48 RA patients at a mean of 7.5 years after CR-TKA. Mean postoperative TD was 9.4 ± 0.95 mm, representing an increase of about 1.5–1.8 mm compared to preoperative TD, and possibly reflecting resection of the anterior cruciate ligament. Correlation analysis revealed significant negative correlations between ΔTD and both preoperative flexion angle (r = − 0.67, p < 0.001) and preoperative extension angle (r = − 0.63, p < 0.001), suggesting that TD in knees with flexion contracture increased postoperatively. At medium-term follow-up, no patients displayed AP instability, and mean TD was 8.3 ± 0.48 mm. A significant correlation was found between TD and permissible flexion angle (r = 0.61, p < 0.001). These results indicate that TD is basically maintained during the course of CR-TKA in RA, but may be slightly affected by factors other than the PCL itself.