Posterior-stabilized vs cruciate-retaining TKA in osteoarthritic patients with genu recurvatum: a 2-year comparative analysis

Pre-operative genu recurvatum (GR) in patients with knee osteoarthritis (OA) presents a surgical challenge during total knee arthroplasty (TKA). It remains unclear whether cruciate-retaining (CR) or posterior-stabilized (PS) TKA offers superior functional recovery and postoperative stability in this population. In this single-centre retrospective cohort study, we analysed 102 patients with knee OA and physiological GR > 5° who underwent either CR-TKA (n = 60) or PS-TKA (n = 42). Clinical outcomes were assessed preoperatively, at 6 months, and at 2 years postoperatively using range of motion (ROM), and validated functional scores, International Knee Society Score (IKSS), Oxford Knee Score (OKS), Short Form-36 (SF-36). Recurrence of GR, complication rates, and revision procedures were also recorded. Statistical comparisons were performed using independent t-tests and chi-square tests. Both groups demonstrated significant improvements across all functional outcomes. At the 6-month and 2-year follow-ups, the PS-TKA group demonstrated significantly better end range flexion and ROM than the CR-TKA group. At 2 years, recurrence of GR was 9.5% in the PS-TKA group versus 18.3% in the CR-TKA group (p < 0.05). There were no significant differences in IKSS, OKS, SF-36, patient satisfaction or expectation fulfilment. There were no significant differences in complications or revision rates between the groups. Both CR-TKA and PS-TKA provided substantial functional improvement in patients with pre-operative GR. PS-TKA demonstrated superior flexion and lower recurrence rates of GR but no difference in functional outcomes or revision rates. Given its enhanced extension stability, PS-TKA may be preferable in cases with significant posterior laxity. Implant selection should remain individualized based on intraoperative findings and patient-specific anatomical considerations.