Abstract Purpose bi‐cruciate retaining total knee arthroplasty (BCR‐TKA) is recognised as an alternative to a Cruciate Retaining Total Knee Arthroplasty (CR‐TKA) in the pursuit of reducing joint awareness and approaching a ‘forgotten artificial knee joint’. The aim of this retrospective cohort study was to provide a short‐term comparison on functional and clinical outcomes between BCR‐TKA and CR‐TKA in osteoarthritis patients. Methods The cohort consisted of 61 BCR‐TKA patients, matched for age, BMI and sex with 61 CR‐TKA patients. They were operated on between 2014 and 2016. Patient‐Reported Outcome Measurements, including the Forgotten Joint Score (FJS‐12), Oxford Knee Score (OKS), Western Ontario and McMaster Osteoarthritis (WOMAC) and Visual Analogue Score (VAS) pain, were collected preoperatively and at 3‐, 12‐, 24‐months and 5‐years postoperatively. Additionally, domain‐specific questionnaires were included, such as the FJS. Effect size for the FJS‐12 was calculated at the 3‐year follow‐up to quantify the difference between BCR‐ and CR‐TKA. Functional performance was additionally evaluated using a validated balance‐based exergaming system, consisting of a pressure‐sensitive balance platform delivering real‐time visual feedback to quantify dynamic stability. Results At 5‐year follow‐up, BCR‐TKA showed significantly better patient‐reported outcome measures (PROMs) than CR‐TKA, including joint awareness, stiffness, function, pain and daily activity‐related disabilities (FJS‐12, OKS, WOMAC, VAS pain). In the subgroup completing exergaming assessment, BCR‐TKA demonstrated superior dynamic stability (71.91% vs. 66.90%, p = 0.021). The 5‐year survival rate was 98.4% for BCR‐TKA and 95.1% for CR‐TKA, with no significant difference in revision rates. Conclusion BCR‐TKA resulted in superior midterm joint awareness and functional outcomes compared to the CR‐TKA. Additionally, objective data collected through exergaming demonstrated a positive trend in favour of BCR‐TKA, further supporting its functional benefits. This study illustrates that the bi‐cruciate retaining surgical technique for TKA is a promising step toward reducing joint awareness and achieving the ‘forgotten’ artificial knee. As ACL preservation may enhance rotational stability and proprioception, future research should incorporate high‐resolution kinematic analyses such as 3D gait analysis. Level of Evidence Level III therapeutic, retrospective cohort study.
Kalaai et al. (Wed,) studied this question.