High-flexion Total Knee Arthroplasty Improves Flexion of Stiff Knees

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2010 Oct 5

PMID 20890698

Citations 14

Authors

Bum-Sik Lee

Jong-Min Kim

Sang-Jin Lee

Kwang-Hwan Jung

Dae-Hee Lee

Eun-Jong Cha

Seong-Il Bin

Affiliations

Soon will be listed here.

Abstract

Purpose: High-flexion knee prosthesis designs are generally thought to be of benefit only in patients with a satisfactory preoperative flexion angle. The aim of the study was to evaluate whether high-flexion designs were indeed worthless in osteoarthritis patients with severe preoperative flexion limitation.

Methods: The postoperative maximum flexion was compared in osteoarthritis patients with a preoperative maximum flexion of 100° or less, using LPS and LPS-flex implants (NexGen®; Zimmer, Warsaw, IN) in total knee arthroplasties. Data on 39 knees in the LPS group and 41 in the LPS-flex group, with a minimum of 2 years of follow-up, were reviewed retrospectively, focused on the postoperative maximum flexion.

Results: Two years after operation, the LPS-flex group had a mean postoperative maximum flexion of 131±10° (range, 105-140°), which was significantly higher than the 121±12° (range, 95-140°) in the LPS group (P<0.001). In the LPS-flex group, about half of the knees (n=18, 44%) could achieve a maximum flexion of 140° postoperatively, but in the LPS group only five knees (13%) achieved a maximum flexion of 140°.

Conclusion: Despite a different period of the operation between groups, this study suggested that osteoarthritis patients with severe preoperative flexion limitation could achieve more postoperative gain in flexion when a high-flexion prosthesis was used, compared to the flexion obtained using a standard prosthesis.

Citing Articles

Does the severity or cause of preoperative stiffness affect the clinical results and range of motion after total knee arthroplasty?.

Ah Lee S, Kang S, Chang C, Chang M, Kim Y, Song M PLoS One. 2018; 13(10):e0205168.

PMID: 30308050 PMC: 6181344. DOI: 10.1371/journal.pone.0205168.

Analysis of different bicruciate-retaining tibial prosthesis design using a three dimension finite element model.

He P, Li X, Huang S, Liu M, Chen W, Xu D Am J Transl Res. 2017; 9(5):2618-2628.

PMID: 28560009 PMC: 5446541.

Total knee arthroplasty using NexGen LPS-flex® improves clinical outcomes without early loosening: minimum 6-year follow-up results.

Jeon Y, Shin J, Jung J, Kim M J Orthop Surg Res. 2016; 11(1):83.

PMID: 27443675 PMC: 4957306. DOI: 10.1186/s13018-016-0419-5.

Functional versus patient-reported outcome of the bicruciate and the standard condylar-stabilizing total knee arthroplasty.

Vascellari A, Schiavetti S, Rebuzzi E, Coletti N Eur J Orthop Surg Traumatol. 2016; 26(3):305-10.

PMID: 26922063 DOI: 10.1007/s00590-016-1750-6.

High-Flexion Total Knee Arthroplasty Using NexGen LPS-Flex System: Minimum 5-year Follow-up Results.

Rhee S, Hong S, Suh J Knee Surg Relat Res. 2015; 27(3):156-62.

PMID: 26389068 PMC: 4570950. DOI: 10.5792/ksrr.2015.27.3.156.

References

Parsley B, Engh G, Dwyer K . Preoperative flexion. Does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty?. Clin Orthop Relat Res. 1992; (275):204-10. View

Kim Y, Sohn K, Kim J . Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am. 2005; 87(7):1470-5. DOI: 10.2106/JBJS.D.02707. View

Kim Y, Choi Y, Kwon O, Kim J . Functional outcome and range of motion of high-flexion posterior cruciate-retaining and high-flexion posterior cruciate-substituting total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am. 2009; 91(4):753-60. DOI: 10.2106/JBJS.H.00805. View

Lavernia C, DApuzzo M, Rossi M, Lee D . Accuracy of knee range of motion assessment after total knee arthroplasty. J Arthroplasty. 2008; 23(6 Suppl 1):85-91. DOI: 10.1016/j.arth.2008.05.019. View

Li G, Most E, Sultan P, Schule S, Zayontz S, Park S . Knee kinematics with a high-flexion posterior stabilized total knee prosthesis: an in vitro robotic experimental investigation. J Bone Joint Surg Am. 2004; 86(8):1721-9. DOI: 10.2106/00004623-200408000-00017. View

Ritter M, Berend M, Harty L, Davis K, Meding J, Keating E . Predicting range of motion after revision total knee arthroplasty: clustering and log-linear regression analyses. J Arthroplasty. 2004; 19(3):338-43. DOI: 10.1016/j.arth.2003.11.001. View

Moro-oka T, Matsuda S, Miura H, Nagamine R, Urabe K, Kawano T . Patellar tracking and patellofemoral geometry in deep knee flexion. Clin Orthop Relat Res. 2002; (394):161-8. DOI: 10.1097/00003086-200201000-00019. View

Seon J, Park S, Lee K, Yoon T, Kozanek M, Song E . Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am. 2009; 91(3):672-9. DOI: 10.2106/JBJS.H.00300. View

Nutton R, van der Linden M, Rowe P, Gaston P, Wade F . A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components. J Bone Joint Surg Br. 2007; 90(1):37-42. DOI: 10.1302/0301-620X.90B1.19702. View

10.

Sultan P, Most E, Schule S, Li G, Rubash H . Optimizing flexion after total knee arthroplasty: advances in prosthetic design. Clin Orthop Relat Res. 2003; (416):167-73. DOI: 10.1097/01.blo.0000081937.75404.ee. View

11.

Weeden S, Schmidt R . A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty. 2007; 22(3):349-52. DOI: 10.1016/j.arth.2006.04.007. View

12.

Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A . Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br. 2002; 84(1):50-3. DOI: 10.1302/0301-620x.84b1.12432. View

13.

Banks S, Bellemans J, Nozaki H, Whiteside L, Harman M, Hodge W . Knee motions during maximum flexion in fixed and mobile-bearing arthroplasties. Clin Orthop Relat Res. 2003; (410):131-8. DOI: 10.1097/01.blo.0000063121.39522.19. View

14.

Argenson J, Komistek R, Mahfouz M, Walker S, Aubaniac J, Dennis D . A high flexion total knee arthroplasty design replicates healthy knee motion. Clin Orthop Relat Res. 2004; (428):174-9. DOI: 10.1097/01.blo.0000148948.79128.76. View

15.

Massin P, Gournay A . Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplasty. 2006; 21(6):889-96. DOI: 10.1016/j.arth.2005.10.019. View

16.

Jakobsen T, Christensen M, Christensen S, Olsen M, Bandholm T . Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?. Physiother Res Int. 2009; 15(3):126-34. DOI: 10.1002/pri.450. View

17.

Victor J, Ries M, Bellemans J, Robb W, van Hellemondt G . High-flexion, motion-guided total knee arthroplasty: who benefits the most?. Orthopedics. 2007; 30(8 Suppl):77-9. View

18.

Kim Y, Choi Y, Kim J . Range of motion of standard and high-flexion posterior cruciate-retaining total knee prostheses a prospective randomized study. J Bone Joint Surg Am. 2009; 91(8):1874-81. DOI: 10.2106/JBJS.H.00769. View

19.

Anouchi Y, McShane M, Kelly Jr F, ELTING J, Stiehl J . Range of motion in total knee replacement. Clin Orthop Relat Res. 1996; (331):87-92. DOI: 10.1097/00003086-199610000-00012. View

20.

Huddleston J, Scarborough D, Goldvasser D, Freiberg A, Malchau H . 2009 Marshall Urist Young Investigator Award: how often do patients with high-flex total knee arthroplasty use high flexion?. Clin Orthop Relat Res. 2009; 467(7):1898-906. PMC: 2690769. DOI: 10.1007/s11999-009-0874-y. View