Comparison of Periprosthetic Bone Mineral Density between Cruciate-Retaining and Posterior-Stabilised Designs in Cementless Total Knee Arthroplasty

Comparison of Periprosthetic Bone Mineral Density between Cruciate-Retaining and Posterior-Stabilised Designs in Cementless Total Knee Arthroplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Periprosthetic Bone Mineral Density between Cruciate-Retaining and Posterior-Stabilised Designs in Cementless Total Knee Arthroplasty Akira Saitoh, Naoki Nakano, Thoshiki Kitamura, Takuma Hayashi, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7909346/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Cementless total knee arthroplasty (TKA) avoids cement-related complications and has demonstrated favourable implant survival rates. However, postoperative periprosthetic bone resorption may increase the risk of implant migration. In this study, we aimed to compare periprosthetic bone mineral density (BMD) changes between cruciate-retaining (CR) and posterior-stabilised (PS) cementless TKA. Methods We retrospectively analysed 62 knees that underwent cementless TKA between June 2017 and December 2023. Preoperative and postoperative range of motion (ROM) and the 2011 Knee Society Score (KSS) were assessed. Periprosthetic BMD around the tibial component was assessed by measuring the intensity of radiographic images in five predefined regions of interest (ROIs) using ImageJ immediately after surgery, and at 6 and 12 months postoperatively. Results Of the 62 knees, 32 received the CR design and 30 received the PS design. Postoperatively, both groups demonstrated significant improvements in ROM and 2011 KSS (p < 0.001 for both). There were no significant differences in postoperative clinical outcomes between the groups. At 12 months, the PS group had significantly lower relative brightness values in all ROIs than the CR group (p < 0.05). Multiple regression analysis revealed that only implant design influenced periprosthetic BMD loss across all ROIs. Conclusion Compared with CR cementless TKA, PS cementless TKA was associated with greater periprosthetic BMD loss. Careful implant selection and long-term monitoring are necessary to ensure implant stability and evaluate clinical outcomes. Total knee arthroplasty Bone mineral density Cementless fixation Cruciate-retaining Posterior-stabilised Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7909346","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":545707078,"identity":"358b32ea-8ede-4959-8a96-66a1ea1b0bf7","order_by":0,"name":"Akira Saitoh","email":"","orcid":"","institution":"Kobe University","correspondingAuthor":false,"prefix":"","firstName":"Akira","middleName":"","lastName":"Saitoh","suffix":""},{"id":545707079,"identity":"6af3b352-fdbb-45bc-8278-b8deef297514","order_by":1,"name":"Naoki 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Arthroplasty","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Total knee arthroplasty, Bone mineral density, Cementless fixation, Cruciate-retaining, Posterior-stabilised","lastPublishedDoi":"10.21203/rs.3.rs-7909346/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7909346/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eCementless total knee arthroplasty (TKA) avoids cement-related complications and has demonstrated favourable implant survival rates. However, postoperative periprosthetic bone resorption may increase the risk of implant migration. In this study, we aimed to compare periprosthetic bone mineral density (BMD) changes between cruciate-retaining (CR) and posterior-stabilised (PS) cementless TKA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe retrospectively analysed 62 knees that underwent cementless TKA between June 2017 and December 2023. Preoperative and postoperative range of motion (ROM) and the 2011 Knee Society Score (KSS) were assessed. Periprosthetic BMD around the tibial component was assessed by measuring the intensity of radiographic images in five predefined regions of interest (ROIs) using ImageJ immediately after surgery, and at 6 and 12 months postoperatively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 62 knees, 32 received the CR design and 30 received the PS design. Postoperatively, both groups demonstrated significant improvements in ROM and 2011 KSS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both). There were no significant differences in postoperative clinical outcomes between the groups. At 12 months, the PS group had significantly lower relative brightness values in all ROIs than the CR group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multiple regression analysis revealed that only implant design influenced periprosthetic BMD loss across all ROIs.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eCompared with CR cementless TKA, PS cementless TKA was associated with greater periprosthetic BMD loss. Careful implant selection and long-term monitoring are necessary to ensure implant stability and evaluate clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Comparison of Periprosthetic Bone Mineral Density between Cruciate-Retaining and Posterior-Stabilised Designs in Cementless Total Knee Arthroplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 13:23:40","doi":"10.21203/rs.3.rs-7909346/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"633f92f0-a339-40f1-b391-0a1d7b7a7f6a","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T00:23:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-17 13:23:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7909346","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7909346","identity":"rs-7909346","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}