Bicruciate retaining total knee arthroplasty : results throughout history

Approximately 20% amongst patients are dissatisfied after total knee arthroplasty (TKA). Bicruciate retaining (BCR) TKA offers superior knee kinematics and proprioception, but many surgeons abandoned its use because of complications and technical difficulties. Recently, two new BCR implant designs were introduced : Vanguard XP (Zimmer Biomet) and Journey XR (Smith&Nephew). We searched Pubmed, Limo, Embase and Cochrane, screened reference lists of eligible studies and included studies that met the inclusion criteria. We included 35 articles reporting on ten different BCR implants, including three articles presenting results of the Vanguard XP prosthesis. Unfortunately, no articles reporting on the results of the Journey XR prosthesis had been published. The BCR implants of the early 1970s showed good functional results, but a high rate of complications, mainly loosening and infections. The Townley Anatomic TKA was the first BCR implant with good clinical results, a low incidence of loosening and a high survivorship. One article of the three reporting on the Vanguard XP yielded high patient satisfaction (94%) with two revisions (1.4%). The two other articles reported three revisions (5%) after one year of follow-up and 19 revisions (13.4%) after three years of follow-up. Throughout history, the functional results of BCR TKA improved, with lessening of the complications. The short-term results of the Vanguard XP implant showed good functional results, but two out of three articles reported a high rate of loosening. Based on the results reported in this review, the use of BCR TKA is still debatable. Further high-level evidence research is necessary to assess the clinical benefit of BCR TKA.