Anatomical bi-cruciate retaining TKA improves gait ability earlier than bi-cruciate stabilized TKA based on triaxial accelerometery data: A prospective cohort study

BACKGROUND: Total knee arthroplasty (TKA) is a common and cost-effective surgical treatment for osteoarthritis of the knee. However, only 82-89% of patients who performed TKA are satisfied with the postoperative outcomes. Therefore, bi-cruciate retaining (BCR) TKA is re-attracting attention. By retaining the anterior cruciate ligament (ACL), the knee may obtain the kinematic pathway that are closer to the native knee. The aim of the present study is to compare the ability to walk before and after surgery in patients who underwent bi-cruciate retaining total knee arthroplasty (BCR TKA) versus bi-cruciate stabilized (BCS) TKA during the early postoperative period. METHODS: Subjects included patients who underwent BCR TKA (10 knees) and BCS TKA (15 knees). We administered 10-meter gait tests before surgery and at 6 weeks and 3 months after surgery. We collected the following triaxial accelerometery data with a portable gait analyzer: walking time, number of steps, velocity, stride length, and coefficient of variability (CV) of double-leg support time while walking. RESULTS: Patients who underwent BCR TKA improved their gait ability [walking time (p < 0.01), number of steps (p < 0.05), velocity (p < 0.01), and stride length (p < 0.01) more than those who received BCS TKA at 6 weeks after surgery. BCR TKA improved gait ability (walking time, number of steps, velocity, and stride length) more than BCS TKA at 6 weeks after surgery. At 6 weeks after surgery, CV of double-leg support time while walking improved more in the BCR TKA group than in the BCS TKA group (p < 0.05). CONCLUSIONS: BCR TKA is associated with improved gait ability in the early postoperative period.