Stable 2-year migration on radiostereometric analysis and improved gait speed and function after bicruciate-retaining TKA: a prospective cohort of 25 patients
DOI:
https://doi.org/10.2340/17453674.2026.46950Keywords:
Arthroplasty, Implants, Knee, Osteoarthrosis, Radiological imaging, Radiostereometric analysisAbstract
Background and purpose: In bicruciate-retaining total knee arthroplasty (BCR TKA) the preservation of both cruciate ligaments necessitates a different tibial tray design with reduced bone–implant interface. These ligaments also influence knee joint force dynamics and may thereby affect component migration. The primary aim of our study was to assess the fixation of BCR TKA up to 2 years postoperatively. Secondary aims included the evaluation of clinical and functional outcomes.
Methods: This prospective study (https://osf.io/zqt8d) included 25 BCR TKA patients. Migration of both components was assessed at different follow-up time points by model-based radiostereometric analysis (RSA) using bone markers. Primary outcome was total translation (TT) and total rotation (TR) at the 2-year follow-up. Secondary outcomes included at-home gait parameters (gait speed, stride length, stride time) assessed with wearable sensors, patient-reported outcome measures (PROMs), and adverse events (AEs).
Results: At the 2-year follow-up, least-squares mean tibial TT was 0.22 mm (95% confidence interval [CI] 0.16–0.28) (tibia) and femoral TT 0.43 mm (CI 0.30–0.57). The least-squares mean tibial TR was 0.53° (CI 0.43–0.63) and femoral TR 0.64° (CI 0.46–0.82). PROMs improved significantly after surgery, with improvements exceeding the predefined minimal clinically important difference (MCID). Gait outcomes revealed a significant gait speed improvement, which remained below MCID, and no significant difference from healthy controls 1 year postoperatively. AEs included 2 intraoperative tibial eminence fractures, 4 cases of persistent postoperative pain, and 2 cases of postoperative oedema with temporary knee stiffness.
Conclusion: RSA analysis of this BCR TKA demonstrated a stabilizing migration pattern that remained below established TKA benchmark values (for different designs), indicating good fixation at 2-year follow-up. The findings were accompanied by an improved PROM, whereas gait speed improvement was below MCID.
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Mills K, Wymenga A B, Benard M R, Kaptein B L, Defoort K C, van Hellemondt G G, et al. Fluoroscopic and radiostereometric analysis of a bicruciate-retaining versus a posterior cruciate-retaining total knee arthroplasty: a randomized controlled trial. Bone Joint J 2023; 105-B(1): 35-46. doi: 10.1302/0301-620X.105B1.BJJ-2022-0465.R2.
Okada Y, Teramoto A, Takagi T, Yamakawa S, Sakakibara Y, Shoji H, et al. ACL function in bicruciate-retaining total knee arthroplasty. J Bone Joint Surg Am 2018; 100(17): e114. doi: 10.2106/JBJS.18.00099.
Mills K, Defoort K, van Hellemondt G, Heesterbeek P. Implant stability and clinical performance of a bicruciate-retaining total knee arthroplasty: a radiostereometric analysis up to 7.5 years follow-up. Clin Biomech (Bristol) 2025; 124: 106473. doi: 10.1016/j.clinbiomech.2025.106473.
Cools A S, Luyckx T, Victor J, Arnout N. Bicruciate retaining total knee arthroplasty: current state and future promise. Acta Orthop Belg 2023; 89(3): 423-8. doi: 10.52628/89.3.11663.
World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA 2025; 333(1): 71-4. doi: 10.1001/jama.2024.21972.
Kaptein B L, Pijls B, Koster L, Karrholm J, Hull M, Niesen A, et al. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95: 256-67. doi: 10.2340/17453674.2024.40709.
Cuschieri S. The STROBE guidelines. Saudi J Anaesth 2019; 13(Suppl 1): S31-S4. doi: 10.4103/sja.SJA_543_18.
Mendoza T, Mayne T, Rublee D, Cleeland C. Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. Eur J Pain 2006; 10(4): 353-61. doi: 10.1016/j.ejpain.2005.06.002.
Kellgren J H, Lawrence J S. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16(4): 494-502. doi: 10.1136/ard.16.4.494.
Boekesteijn R J, Keijsers N L W, Defoort K, Mancini M, Bruning F J, El-Gohary M, et al. Real-world gait and turning in individuals scheduled for total knee arthroplasty. Clin Biomech (Bristol) 2024; 119:106332. doi: 10.1016/j.clinbiomech.2024.106332.
Shah V V, McNames J, Mancini M, Carlson-Kuhta P, Nutt J G, El-Gohary M, et al. Digital biomarkers of mobility in Parkinson’s disease during daily living. J Parkinsons Dis 2020; 10(3): 1099-111. doi: 10.3233/JPD-201914.
Morris R, Stuart S, McBarron G, Fino P C, Mancini M, Curtze C. Validity of Mobility Lab (version 2) for gait assessment in young adults, older adults and Parkinson’s disease. Physiol Meas 2019; 40(9): 095003. doi: 10.1088/1361-6579/ab4023.
de Groot I B, Favejee M M, Reijman M, Verhaar J A, Terwee C B. The Dutch version of the Knee Injury and Osteoarthritis Outcome Score: a validation study. Health Qual Life Outcomes 2008; 6: 16. doi: 10.1186/1477-7525-6-16.
Murray D W, Fitzpatrick R, Rogers K, Pandit H, Beard D J, Carr A J, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89(8): 1010-14. doi: 10.1302/0301-620X.89B8.19424.
Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20(10): 1727-36. doi: 10.1007/s11136-011-9903-x.
Insall J N, Dorr L D, Scott R D, Scott W N. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989(248): 13-14.
Lizaur-Utrilla A, Gonzalez-Parreno S, Martinez-Mendez D, Miralles-Munoz F A, Lopez-Prats F A. Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sports Traumatol Arthrosc 2020; 28(5): 1473-8. doi: 10.1007/s00167-019-05543-x.
Watabe T, Sengoku T, Kubota M, Sakurai G, Yoshida S, Taniguchi Y. Knee injury and osteoarthritis outcome score and knee society score for the minimal clinically important differences after cruciate-retaining total knee arthroplasty: two-year follow up. Knee 2025; 53: 176-82. doi: 10.1016/j.knee.2024.12.015.
Deckey D G, Verhey J T, Gerhart C R B, Christopher Z K, Spangehl M J, Clarke H D, et al. There are considerable inconsistencies among minimum clinically important differences in TKA: a systematic review. Clin Orthop Relat Res 2023; 481(1): 63-80. doi: 10.1097/CORR.0000000000002440.
Fan X Y, Ma J H, Wu X, Xu X, Shi L, Li T, et al. How much improvement can satisfy patients? Exploring patients’ satisfaction 3 years after total knee arthroplasty. J Orthop Surg Res 2021; 16(1): 389. doi: 10.1186/s13018-021-02514-2.
Clement N D, Scott C E H, Hamilton D F, MacDonald D, Howie C R. Meaningful values in the Forgotten Joint Score after total knee arthroplasty. Bone Joint J 2021; 103-B(5): 846-54. doi: 10.1302/0301-620X.103B5.BJJ-2020-0396.R1.
Bohannon R W, Glenney S S. Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract 2014; 20(4): 295-300. doi: 10.1111/jep.12158.
Valstar E R, Gill R, Ryd L, Flivik G, Borlin N, Karrholm J. Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop 2005; 76(4): 563-72. doi: 10.1080/17453670510041574.
Pijls B G, Plevier J W M, Nelissen R. RSA migration of total knee replacements. Acta Orthop 2018; 89(3): 320-8. doi: 10.1080/17453674.2018.1443635.
Pijls B G, Valstar E R, Nouta K A, Plevier J W, Fiocco M, Middeldorp S, et al. Early migration of tibial components is associated with late revision: a systematic review and meta-analysis of 21,000 knee arthroplasties. Acta Orthop 2012; 83(6): 614-24. doi: 10.3109/17453674.2012.747052.
Ryd L, Albrektsson B E, Carlsson L, Dansgard F, Herberts P, Lindstrand A, et al. Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Joint Surg Br 1995; 77(3): 377-83
Pijls B G, Laende E K. The full radiostereometric analysis migration pattern of tibial components is associated with aseptic loosening: introducing MTPMemax (MTPM estimated maximum). Bone Joint Res 2025; 14(5): 398-406. doi: 10.1302/2046-3758.145.BJR-2024-0554.
Yamagami R, Nishiike O, Kuwasawa A, Ishii K, Hamada D, Ryu K, et al. Anatomically-designed bicruciate-retaining total knee arthroplasty demonstrates good two-year survivorship and improvements in patient-reported outcomes: a prospective multicenter single-arm study. J Exp Orthop 2025; 12(4): e70567. doi: 10.1002/jeo2.70567.
Kinoshita T, Mortensen K R L, Ingelsrud L H, Muharemovic O, Gromov K, Troelsen A. Bicruciate-retaining versus cruciate-retaining total knee arthroplasty in implant fixation: a 10-year follow-up of a randomized RSA trial. Acta Orthop 2026; 97: 672-7. doi: 10.2340/17453674.2026.46805.
Bruning F J, Boekesteijn R J, Defoort K C, Susan S, van den Ende C H M, Smulders K. Recovery of daily-life walking after total knee arthroplasty: a two-year longitudinal study and comparison with healthy controls. Osteoarthr Cartil Open 2026; 8(3): 100835. doi: 10.1016/j.ocarto.2026.100835.
De Faoite D, Ries C, Foster M, Boese C K. Indications for bi-cruciate retaining total knee replacement: an international survey of 346 knee surgeons. PLoS One 2020; 15(6): e0234616. doi: 10.1371/journal.pone.0234616.
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Copyright (c) 2026 Kelly Mills, Simon N van Laarhoven, Koen C Defoort, Saskia Susan, Petra J C Heesterbeek
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