Ultracongruent Versus Posterior-Stabilized Polyethylene: No Difference in Anterior Knee Pain but Decreased Noise Generation

Abstract

Background: Noise generation and anterior knee pain can occur after primary total knee arthroplasty (TKA) and may affect patient satisfaction. Polyethylene design in cruciate-sacrificing implants could be a variable influencing these complications. The purpose of this study was to analyze the effect of polyethylene design on noise generation and anterior knee pain. Methods: We prospectively reviewed a cohort of patients who underwent primary TKA between 2014 and 2022 by a single surgeon using either a posterior-stabilized (PS) or ultracongruent (UC) polyethylene of the same implant design. The primary outcomes were measured through a noise generation questionnaire and the Knee Injury and Osteoarthritis Outcome Score-Patellofemoral score. Results: A total of 409 TKA procedures were included, 153 (37.4%) PS and 256 (62.6%) UC. No difference was noted in the Knee Injury and Osteoarthritis Outcome Score-Patellofemoral score between PS and UC designs (71.7 ± 26 versus 74.2 ± 23.2, P = 0.313). A higher percentage of patients in the PS cohort reported hearing (32.7% versus 22.3%, P = 0.020) or feeling noise (28.8 versus 20.3, P = 0.051) coming from their implant. No notable difference was observed in noise-related satisfaction rates. Independent risk factors of noise generation were age (OR, 0.96; P = 0.006) and PS polyethylene (OR, 1.61; P = 0.043). Noise generation was associated with decreased patient-reported outcome measure scores (P < 0.001). Conclusion: While there was no difference in anterior knee pain between PS and UC polyethylene designs, PS inserts exhibit higher rates of noise generation compared with UC. Noise generation had comparable satisfaction but was associated with decreased patient-reported outcome measure scores.