Second-generation bicruciate-retaining TKA shows 5.7% revision rate in meta-analysisNew knee implant design shows low revision rate

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie Published July 5, 2026 Study authors: Kompala Varun, Elmenawi Khaled A, Wedgwood Maile, Sherif Islam A, Hackett Loren, Ramos Michael S, Lo… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider second-generation BCR TKA as a durable option, but note high heterogeneity and lack of direct comparisons with other modern implants.

This meta-analysis of 13 studies including 1087 second-generation bicruciate-retaining (BCR) total knee arthroplasty (TKA) implants evaluated all-cause revision rates and survivorship in patients undergoing primary TKA. The mean follow-up was 2.6 years.

The primary outcome was the all-cause revision rate. Overall, 5.7% of knees (62 out of 1087) were revised. The pooled all-cause revision rate was 1.6 per 100 person-years (95% CI 0.009-0.023). The authors note that these revision rates are lower than historical reports for first-generation BCR designs, suggesting improved durability with modern implants.

Key limitations include significant heterogeneity (I²=75.5%, p<0.001) and the need for more long-term comparative data. The analysis does not directly compare modern BCR implants to other contemporary TKA designs, such as posterior-stabilized or cruciate-retaining prostheses.

For practice, these findings support the continued use of second-generation BCR TKA, but clinicians should interpret the results cautiously given the heterogeneity and lack of direct comparisons with other current implant types.

How this fits prior evidence

This meta-analysis extends prior coverage on knee osteoarthritis interventions by providing implant-specific outcomes for second-generation BCR TKA. Prior items focused on non-surgical therapies (Tai Chi, exercise, probiotics) and surgical alignment techniques (kinematic vs. mechanical) or patellar management. This analysis addresses a gap by reporting revision rates for a specific implant design, though it does not compare BCR to other contemporary TKA types, contrasting with the comparative nature of the kinematic alignment and patellar resurfacing studies.

A new analysis of 13 studies looked at how well a modern type of knee replacement implant, called a second-generation bicruciate-retaining (BCR) implant, holds up over time. The analysis included 1,087 knee replacements in people with knee osteoarthritis. On average, patients were followed for about 2.6 years.

The researchers found that 5.7% of the knees (62 out of 1,087) needed a second surgery to replace or fix the implant. This works out to about a 1.6% chance of needing revision each year. The authors say this is better than what was seen with older versions of this implant.

However, the results varied a lot between the different studies, which makes the findings less certain. Also, this analysis did not directly compare the new implant to other modern knee replacement designs. So it is not clear if this implant is better than other options available today.

For people with knee osteoarthritis considering knee replacement, this study suggests that the newer BCR design may be a reasonable option. But more long-term studies are needed to see how these implants perform after many years.

What this means for you:

Modern bicruciate-retaining knee implants show a low revision rate, but more long-term comparisons are needed.

Common questions

What is a bicruciate-retaining knee implant?

It is a type of knee replacement that preserves both of the knee's natural cruciate ligaments. The second-generation design is a newer version that aims to improve stability and function.

How many people needed a second surgery?

Out of 1,087 knee replacements, 62 (5.7%) needed a revision surgery within an average of 2.6 years. That means about 1.6% of patients needed a revision each year.

Is this implant better than other knee replacements?

This study did not directly compare this implant to other modern designs. It only shows that the revision rate is lower than older versions of the same implant. More research is needed.

What are the limitations of this study?

The results varied a lot between studies, which makes the findings less reliable. Also, the follow-up time was only about 2.6 years on average, so long-term performance is still unknown.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up31.2 mo

PublishedJul 2026

PMID42384182

View Original Abstract ↓

INTRODUCTION: Bicruciate-retaining (BCR) total knee arthroplasty (TKA) was developed to better replicate native knee biomechanics by preserving both cruciate ligaments. First-generation BCR implants were notorious for technical challenges and suboptimal survivorship. However, advancements in implant design and surgical techniques have renewed interest in second-generation BCR TKA systems. This study aimed to evaluate the overall survivorship of contemporary (second-generation) BCR primary TKA implants. METHODS: A systematic review of PubMed, Scopus, Embase, Web of Science, and Cochrane databases was conducted from inception to January 3, 2025. Inclusion criteria were studies that reported the number of revisions following second-generation BCR TKA. We excluded case reports, review articles, and studies that evaluated first-generation BCR TKA. A total of 1046 articles were retrieved; ultimately, 13 were included. Events per person-years pooled analysis was performed to estimate the incidence of all-cause revision, adjusting for duration of follow-up. Heterogeneity was measured using I test. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 1,087 BCR TKA implants among 13 studies were analyzed. The mean follow-up was 2.6 years. A total of 62 (5.7%) knees were revised. The overall pooled rate of all-cause revision was 1.6 per 100 person-years (95% confidence interval [CI] 0.009-0.023) Heterogeneity among the analyzed studies was significant (I = 75.5%, p < 0.001). CONCLUSION: Contemporary BCR TKA implants showed improved survivorship compared to historical reports, with a low pooled all-cause revision rate of 1.6 per 100 person-years, corresponding to a 1.6% chance of revision per year of follow-up. Despite the associated heterogeneity, these findings suggest that modern BCR designs offer durable outcomes and support their continued use. Further long-term comparative data are needed to better define their role relative to modern knee implants.

Second-generation bicruciate-retaining TKA shows 5.7% revision rate in meta-analysisNew knee implant design shows low revision rate

How this fits prior evidence

Common questions

Study Details

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Second-generation bicruciate-retaining TKA shows 5.7% revision rate in meta-analysisNew knee implant design shows low revision rate

How this fits prior evidence

Common questions

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