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Open Access Technical Note

Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation

Pier Francesco Indelli1235*, Massimiliano Marcucci1, Angelo Graceffa3, Sophie Charlton4 and Leonardo Latella1

Author Affiliations

1 Centro Eccellenza Sostituzioni Articolari Toscana (CESAT), Clinica Ortopedica Universita’ di Firenze, Florence 50134, Italy

2 Fondazione Onlus “In Cammino”, Piazza Lavagnini 1, Fucecchio, Florence 50054, Italy

3 Breyer Center for Overseas Study, Stanford University in Florence, Florence 50100, Italy

4 Clinica Ortopedica Universita’ di Catania, Catania 95121, Italy

5 Libera Universita’ degli Studi di Scienze Umane e Tecnologiche, Lugano 6900, Switzerland

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Journal of Orthopaedic Surgery and Research 2014, 9:54  doi:10.1186/s13018-014-0054-y

Published: 19 July 2014



Intercondylar femoral bone removal during posterior stabilized (PS) total knee arthroplasty (TKA) makes many cruciate substituting implant designs less appealing than cruciate retaining implants. Bone stock conservation is considered fundamental in the prevision of future revision surgeries. The purpose of this study was to compare the quantity of intercondylar bone removable during PS housing preparation using three contemporary PS TKA instrumentations.


We compared different box cutting jigs which were utilized for the PS housing of three popular PS knee prostheses. The bone removal area from every PS box cutting jig was three-dimensionally measured.


Independently from the implant size, the cutting jig for a specific PS TKA always resected significantly less bone than the others: this difference was statistically significant, especially for small- to medium-sized total knee femoral components.


This study does not establish a clinical relevance of removing more or less bone at primary TKA, but suggests that if a PS design is indicated, it is preferable to select a model which possibly resects less distal femoral bone.

TKA; Total knee arthroplasty; Posterior stabilized; Cruciate substituting total knee arthroplasty