Recovery Trajectories After Cruciate Retaining And Posterior Stabilized Total Knee Arthroplasty

Total knee arthroplasty (TKA) is an effective surgical intervention for patients with advanced knee osteoarthritis who experience persistent pain and functional limitations despite conservative treatment. Among contemporary implant designs, cruciate-retaining (CR) and posterior-stabilized (PS) prostheses are the most widely used approaches. CR implants preserve the posterior cruciate ligament (PCL) to maintain more physiological knee kinematics, whereas PS implants substitute PCL function through a post-cam mechanism. Although both designs have demonstrated successful clinical outcomes, evidence regarding their comparative influence on postoperative recovery remains inconclusive.

In recent years, postoperative evaluation after TKA has increasingly emphasized rehabilitation-centered patient-reported outcome measures (PROMs) rather than solely clinician-based assessments. Parameters such as pain, functional status, quality of life, kinesiophobia, and joint awareness provide a more comprehensive understanding of patient recovery and adaptation after surgery. However, studies directly comparing CR and PS TKA from this multidimensional rehabilitation perspective remain limited.

This single-center prospective cohort study was conducted at the Department of Orthopedics and Traumatology, Ondokuz Mayıs University Health Application and Research Center. Patients aged 50 years or older undergoing primary unilateral TKA were included. Participants were allocated to CR or PS groups according to intraoperative surgical decision-making based on posterior cruciate ligament integrity, soft-tissue balance, and routine surgical practice. Standardized perioperative management and postoperative rehabilitation protocols were applied to all participants.

Pain intensity was assessed using the Visual Analog Scale (VAS), functional status with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), and health-related quality of life with the Short Form-36 Health Survey (SF-36). Joint awareness was evaluated postoperatively using the Forgotten Joint Score-12 (FJS-12). Assessments were performed preoperatively and repeated at 3 and 6 months after surgery.

The primary objective of the study was to compare longitudinal recovery trajectories between CR and PS TKA designs across rehabilitation-related PROMs. The study further aimed to determine whether posterior cruciate ligament management influences pain reduction, functional recovery, psychosocial adaptation, and joint awareness during the early postoperative period.