Do Patients Care About Higher Flexion in Total Knee Arthroplasty? A Randomized, Controlled, Double-blinded Trial

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2013 Apr 10

PMID 23565578

Citations 27

Authors

Morten G Thomsen

Henrik Husted

Kristian S Otte

Gitte Holm

Anders Troelsen

Affiliations

Soon will be listed here.

Abstract

Background: Little information exists to support that patients care about flexion beyond what is needed to perform activities of daily living (ADL) after Total knee arthroplasty (TKA). The purpose of this study was to investigate if the achievement of a higher degree of knee flexion after TKA would result in a better patient perceived outcome.

Methods: The study is a randomized, double-blinded, controlled trial in which 36 patients (mean age: 67.2 yrs) undergoing one-stage bilateral TKA randomly received a standard cruciate-retaining (CR) TKA in one knee and a high-flex posterior-stabilized (PS) TKA in the contra lateral knee. At follow-up ROM, satisfaction, pain, "feel" of the knee and the abilities in daily activities were assessed.

Results: At 1-year follow-up we found an expected significantly higher degree of knee flexion of 7° in the high-flex knees (p = 0.001). The high-flex TKA's showed a mean active flexion of 121°. In both TKA's the median VAS pain score was 0, the median VAS satisfaction score was 9, and the median VAS score of the patient "feel" of the knee was 9 at 1-year follow-up. Further, there were no significant differences between the knees in the performance of daily activities.

Conclusions: As expected the high-flex TKA showed increased knee flexion, but no significant differences in the patient perceived outcomes were found. This suggests little relevance to the patients of the difference in knee flexion - when flexion is of this magnitude - as pain free ROM and high patient satisfaction were achieved with both TKA's.

Trial Registration: ClinicalTrials.gov: NCT00294528.

Citing Articles

Virtual versus in-person physiotherapy following total knee arthroplasty: a comparative analysis.

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PMID: 38081949 DOI: 10.1007/s00264-023-06054-8.

The Early Clinical Outcomes Following Unrestricted Caliper Verified Kinematic Alignment Using a Medial Stabilized Design Total Knee Arthroplasty With a Cruciate Retaining Insert.

Munir S, Suzuki L, Hellman J Arthroplast Today. 2023; 24:101250.

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The pre-anesthetic period is the best time to evaluate the knee flexion angle for predicting the flexion angle after total knee arthroplasty: A prospective cohort study.

Ruangsomboon P, Pornrattanamaneewong C, Santanapipatkul P, Sarirasririd S, Chareancholvanich K, Narkbunnam R PLoS One. 2023; 18(2):e0281237.

PMID: 36735740 PMC: 9897552. DOI: 10.1371/journal.pone.0281237.

A high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population.

Han H, Kim J, Lee B, Won S, Lee M BMC Musculoskelet Disord. 2021; 22(1):565.

PMID: 34154538 PMC: 8215776. DOI: 10.1186/s12891-021-04369-4.

"This is not negotiable. You need to do this…": A directed content analysis of decision making in rehabilitation after knee arthroplasty.

Graber J, Lockhart S, Matlock D, Stevens-Lapsley J, Kittelson A J Eval Clin Pract. 2021; 28(1):99-107.

PMID: 34121294 PMC: 8669003. DOI: 10.1111/jep.13591.

References

Miner A, Lingard E, Wright E, Sledge C, Katz J . Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?. J Arthroplasty. 2003; 18(3):286-94. DOI: 10.1054/arth.2003.50046. 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, 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

Dawson J, Fitzpatrick R, Murray D, Carr A . Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998; 80(1):63-9. DOI: 10.1302/0301-620x.80b1.7859. View

Worland R, Johnson G, Alemparte J, Jessup D, Keenan J, Norambuena N . Ten to fourteen year survival and functional analysis of the AGC total knee replacement system. Knee. 2002; 9(2):133-7. DOI: 10.1016/s0968-0160(01)00146-6. View

Shields R, Enloe L, Leo K . Health related quality of life in patients with total hip or knee replacement. Arch Phys Med Rehabil. 1999; 80(5):572-9. DOI: 10.1016/s0003-9993(99)90202-2. View

Husted H, Blond L, Sonne-Holm S, Holm G, Jacobsen T, Gebuhr P . Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients. Acta Orthop Scand. 2004; 74(6):665-9. DOI: 10.1080/00016470310018171. View

Rowe P, Myles C, Walker C, Nutton R . Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?. Gait Posture. 2000; 12(2):143-55. DOI: 10.1016/s0966-6362(00)00060-6. View

Padua R, Ceccarelli E, Bondi R, Campi A, Padua L . Range of motion correlates with patient perception of TKA outcome. Clin Orthop Relat Res. 2007; 460:174-7. DOI: 10.1097/BLO.0b013e318046ccb7. View

10.

Ritter M, Lutgring J, Davis K, Berend M . The effect of postoperative range of motion on functional activities after posterior cruciate-retaining total knee arthroplasty. J Bone Joint Surg Am. 2008; 90(4):777-84. DOI: 10.2106/JBJS.F.01022. View

11.

Devers B, Conditt M, Jamieson M, Driscoll M, Noble P, Parsley B . Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty?. J Arthroplasty. 2010; 26(2):178-86. DOI: 10.1016/j.arth.2010.02.008. View

12.

Shoji H, Solomonow M, Yoshino S, DAmbrosia R, Dabezies E . Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics. 1990; 13(6):643-9. DOI: 10.3928/0147-7447-19900601-08. View

13.

Ritter M, Campbell E . Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty. 1987; 2(2):95-7. DOI: 10.1016/s0883-5403(87)80015-3. View

14.

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

15.

Meneghini R, Pierson J, Bagsby D, Ziemba-Davis M, Berend M, Ritter M . Is there a functional benefit to obtaining high flexion after total knee arthroplasty?. J Arthroplasty. 2007; 22(6 Suppl 2):43-6. DOI: 10.1016/j.arth.2007.03.011. View

16.

Bachmeier C, March L, Cross M, Lapsley H, Tribe K, Courtenay B . A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage. 2001; 9(2):137-46. DOI: 10.1053/joca.2000.0369. View

17.

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

18.

Fortin P, Clarke A, Joseph L, Liang M, Tanzer M, Ferland D . Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999; 42(8):1722-8. DOI: 10.1002/1529-0131(199908)42:8<1722::AID-ANR22>3.0.CO;2-R. View

19.

Pritchett J . Patient preferences in knee prostheses. J Bone Joint Surg Br. 2004; 86(7):979-82. DOI: 10.1302/0301-620x.86b7.14991. View

20.

Bin S, Nam T . Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc. 2006; 15(4):350-5. DOI: 10.1007/s00167-006-0202-y. View