{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:59:37Z","timestamp":1788562777224,"version":"build-2803163510"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Many authors and the data of multiple registries have suggested that the use of posterior cruciate-substituting (posterior stabilized [PS]) total knee arthroplasty (TKA) leads to a higher risk of revision compared with the use of posterior cruciate-retaining (CR) TKA. The aim of the present prospective, randomized, long-term study was to compare PS and CR TKA with regard to the clinical, radiographic, and computed tomography (CT) results; the prevalence of osteolysis; revision rate; and survivorship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study included a consecutive series of 300 patients (mean age [and standard deviation], 63.6 \u00b1 6 years) who underwent simultaneous, bilateral TKA in the same anesthetic session. Each patient received a NexGen CR-Flex prosthesis on 1 side and a NexGen LPS-Flex prosthesis on the contralateral side. The mean follow-up period was 18 years (range, 17.5 to 19.5 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>There were no significant differences between the NexGen CR and LPS-Flex TKA groups at the latest follow-up with regard to the mean Knee Society knee score (93 versus 92 points, respectively); the Western Ontario and McMaster Universities Osteoarthritis Index score (19.1 points for both); the University of California Los Angeles activity score (6.1 points for both); range of motion (125\u00b0 \u00b1 6.1\u00b0 versus 126\u00b0 \u00b1 6.5\u00b0); radiographic and CT results; and revision rate (6.0% versus 6.3%). No knee had osteolysis. The estimated survival rate at 19.5 years was 94% (95% confidence interval [CI], 91% to 100%) for the NexGen CR-Flex prosthesis and 93.7% (95% CI, 91% to 100%) for the LPS-Flex prosthesis, with revision or aseptic loosening as the end point.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The findings of the present, long-term (minimum follow-up of 17.5 years) clinical study showed that NexGen CR-Flex and NexGen LPS-Flex implants produced excellent clinical and radiographic results. There was no notable clinical advantage of a NexGen CR-Flex implant over a NexGen LPS-Flex implant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.00007","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T15:01:33Z","timestamp":1727449293000},"page":"1978-1985","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["No Discernible Difference in Revision Rate or Survivorship Between Posterior Cruciate-Retaining and Posterior Cruciate-Substituting TKA"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2090-7315","authenticated-orcid":false,"given":"Young-Hoo","family":"Kim","sequence":"first","affiliation":[{"name":"The Joint Replacement Center of Seoul Metropolitan Government, SeoNam Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6269-6451","authenticated-orcid":false,"given":"Jang-Won","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul Hospital, Ewha Womans University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3586-9446","authenticated-orcid":false,"given":"Young-Soo","family":"Jang","sequence":"additional","affiliation":[{"name":"The Joint Replacement Center of Seoul Metropolitan Government, SeoNam Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8617-2417","authenticated-orcid":false,"given":"Eun-Jung","family":"Kim","sequence":"additional","affiliation":[{"name":"The Joint Replacement Center of Seoul Metropolitan Government, SeoNam Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,9,27]]},"reference":[{"issue":"8","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1054\/arth.2001.28367","article-title":"Cruciate-retaining and cruciate-substituting total knee arthroplasty: an in vitro comparison of the kinematics under muscle loads","volume":"16","author":"Li","year":"2001","journal-title":"J Arthroplasty."},{"issue":"9","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.arth.2014.03.050","article-title":"A prospective, randomized comparison of posterior stabilized versus cruciate-substituting total knee arthroplasty: a preliminary report with minimum 2-year results","volume":"29","author":"Scott","year":"2014","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1302\/0301-620X.95B11.32835","article-title":"Which total knee replacement implant should I pick? Correcting the pathology: the role of knee bearing designs","volume":"95-B","author":"Berend","year":"2013","journal-title":"Bone Joint J."},{"issue":"17","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.2106\/JBJS.21.01251","article-title":"Revision risk for total knee arthroplasty polyethylene designs in patients 65 years of age or older: an analysis from the American Joint Replacement Registry","volume":"104","author":"Kendall","year":"2022","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"753","DOI":"10.2106\/JBJS.H.00805","article-title":"Functional outcome and range of motion of high-flexion posterior cruciate-retaining and high-flexion posterior cruciate-substituting total knee prostheses. A prospective, randomized study","volume":"91","author":"Kim","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/S0883-5403(97)90156-X","article-title":"The posterior cruciate ligament in total knee arthroplasty","volume":"12","author":"Sorger","year":"1997","journal-title":"J Arthroplasty."},{"key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/00003086-200111000-00025","article-title":"Posterior-stabilized and cruciate-retaining total knee replacement: a randomized study","volume":"392","author":"Clark","year":"2001","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/S0883-5403(98)90091-2","article-title":"Posterior cruciate ligament-sparing versus posterior cruciate ligament-sacrificing arthroplasty. Functional results using the same prosthesis","volume":"13","author":"Pereira","year":"1998","journal-title":"J Arthroplasty."},{"issue":"7","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/S0883-5403(97)90008-5","article-title":"Kinematics of posterior cruciate ligament-retaining and -sacrificing mobile bearing total knee arthroplasties. An in vitro comparison of the New Jersey LCS meniscal bearing and rotating platform prostheses","volume":"12","author":"Lewandowski","year":"1997","journal-title":"J Arthroplasty."},{"issue":"5","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1054\/arth.2000.4638","article-title":"The cruciate ligaments in total knee arthroplasty: a kinematic analysis of 2 total knee arthroplasties","volume":"15","author":"Stiehl","year":"2000","journal-title":"J Arthroplasty."},{"issue":"Suppl 4","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"182","DOI":"10.2106\/00004623-200612001-00019","article-title":"Why posterior cruciate-retaining and substituting total knee replacements have similar ranges of motion. The importance of posterior condylar offset and cleanout of posterior condylar space","volume":"88","author":"Goldstein","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"328","DOI":"10.2106\/00004623-200402000-00016","article-title":"Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses","volume":"86","author":"Swanik","year":"2004","journal-title":"J Bone Joint Surg Am."},{"key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00003086-200107000-00007","article-title":"Total knee arthroplasty using cruciate-retaining kinematic condylar prosthesis","volume":"388","author":"Sextro","year":"2001","journal-title":"Clin Orthop Relat Res."},{"key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/00003086-199907000-00024","article-title":"Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses","volume":"364","author":"Dejour","year":"1999","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"598","DOI":"10.2106\/JBJS.C.00591","article-title":"Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years","volume":"87","author":"Dixon","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1302\/0301-620X.85B3.13182","article-title":"The role of the posterior cruciate ligament in total knee replacement","volume":"85","author":"Misra","year":"2003","journal-title":"J Bone Joint Surg Br."},{"issue":"7","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.arth.2004.06.006","article-title":"The PCL significantly affects the functional outcome of total knee arthroplasty","volume":"19","author":"Conditt","year":"2004","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.arth.2012.05.010","article-title":"Cruciate-retaining vs posterior-substituting inserts in total knee arthroplasty: functional outcome comparison","volume":"28","author":"Lozano-Calder\u00f3n","year":"2013","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.knee.2011.05.003","article-title":"Gait analysis comparison of cruciate retaining and substituting TKA following PCL sacrifice","volume":"19","author":"Joglekar","year":"2012","journal-title":"Knee."},{"issue":"4","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.otsr.2013.03.014","article-title":"Survival analysis of total knee arthroplasty at a minimum 10 years\u2019 follow-up: a multicenter French nationwide study including 846 cases","volume":"99","author":"Argenson","year":"2013","journal-title":"Orthop Traumatol Surg Res."},{"issue":"3","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.arth.2016.08.030","article-title":"A randomized clinical trial comparing posterior cruciate-stabilizing vs posterior cruciate-retaining prostheses in primary total knee arthroplasty: 10-year follow-up","volume":"32","author":"Beaupre","year":"2017","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.arth.2014.09.009","article-title":"Ten-year results comparing posterior cruciate-retaining versus posterior cruciate-substituting total knee arthroplasty","volume":"30","author":"Sando","year":"2015","journal-title":"J Arthroplasty."},{"issue":"22","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.2106\/JBJS.J.01143","article-title":"Increased long-term survival of posterior cruciate-retaining versus posterior cruciate-stabilizing total knee replacements","volume":"93","author":"Abdel","year":"2011","journal-title":"J Bone Joint Surg Am."},{"key":"bib25-20250430","year":"2019","journal-title":"20th annual report"},{"issue":"6","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1080\/17453674.2018.1518570","article-title":"Higher mid-term revision rates of posterior stabilized compared with cruciate retaining total knee arthroplasties: 133,841 cemented arthroplasties for osteoarthritis in the Netherlands in 2007-2016","volume":"89","author":"Spekenbrink-Spooren","year":"2018","journal-title":"Acta Orthop."},{"issue":"Suppl 277","key":"bib29-20250430","first-page":"7","article-title":"Osteoarthrosis of the knee. A radiographic investigation","author":"Ahlb\u00e4ck","year":"1968","journal-title":"Acta Radiol Diagn (Stockh)."},{"issue":"9","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.2106\/00004623-199509000-00006","article-title":"Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note","volume":"77","author":"Arima","year":"1995","journal-title":"J Bone Joint Surg Am."},{"key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00003086-198911000-00004","article-title":"Rationale of the Knee Society clinical rating system","volume":"248","author":"Insall","year":"1989","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"bib32-20250430","first-page":"1833","article-title":"Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"Bellamy","year":"1988","journal-title":"J Rheumatol."},{"issue":"8","key":"bib33-20250430","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S0883-5403(98)90195-4","article-title":"Assessing activity in joint replacement patients","volume":"13","author":"Zahiri","year":"1998","journal-title":"J Arthroplasty."},{"issue":"282","key":"bib36-20250430","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric Estimation from Incomplete Observations","volume":"53","author":"Kaplan","year":"1958","journal-title":"J Am Stat Assoc."},{"issue":"8","key":"bib37-20250430","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1308\/rcsann.2017.0086","article-title":"Cruciate Retaining compared with Posterior Stabilised Nexgen total knee arthroplasty: results at 10 years in a matched cohort","volume":"99","author":"Mayne","year":"2017","journal-title":"Ann R Coll Surg Engl."},{"issue":"3","key":"bib38-20250430","doi-asserted-by":"crossref","first-page":"390","DOI":"10.2106\/00004623-200103000-00011","article-title":"Tibial post wear in posterior stabilized total knee arthroplasty. An unrecognized source of polyethylene debris","volume":"83","author":"Puloski","year":"2001","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib39-20250430","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0883-5403(05)80209-8","article-title":"Intercondylar distal femoral fracture. An unreported complication of posterior-stabilized total knee arthroplasty","volume":"10","author":"Lombardi","year":"1995","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib40-20250430","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00590-019-02370-1","article-title":"Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty: a meta-analysis of clinical trials","volume":"29","author":"Migliorini","year":"2019","journal-title":"Eur J Orthop Surg Traumatol."},{"issue":"2","key":"bib41-20250430","doi-asserted-by":"crossref","first-page":"259","DOI":"10.2106\/00004623-200302000-00012","article-title":"Factors affecting the durability of primary total knee prostheses","volume":"85","author":"Rand","year":"2003","journal-title":"J Bone Joint Surg Am."},{"key":"bib42-20250430","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/01.blo.0000153077.79573.a4","article-title":"Reproducible assessment of radiolucent lines in total knee arthroplasty","volume":"434","author":"Bach","year":"2005","journal-title":"Clin Orthop Relat Res."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:51:55Z","timestamp":1787752315000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,27]]},"references-count":37,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.00007","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,27]]}}}