The Insall Award. Total knee replacement with posterior cruciate ligament retention in patients with a fixed varus deformity.

A group of patients with a preoperative varus contracture of at least 15 degrees underwent total knee replacement with retention of the posterior cruciate ligament. Their outcomes at 10 years were compared with a group of patients with similar contractures in whom a posterior stabilized implant was used, and to a group of patients in whom there was no contracture. In the contracture group where the posterior cruciate ligament was retained, there was an increased incidence of pain, an increased incidence of bone cement radiolucencies, and a decrease in the eventual flexion arc. There was likewise an increased revision rate and a decreased survivorship. In patients with such contractures, the posterior cruciate ligament is a part of the deformity; the deformity cannot be corrected by medial release procedures alone. All these results suggest that for the patient with a fixed varus contracture a posterior cruciate release should be performed and a posterior stabilized type of implant used.