Mobile-bearing Prosthesis and Intraoperative Gap Balancing Are Not Predictors of Superior Knee Flexion: a Prospective Randomized Study

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2014 Jan 18

PMID 24435222

Citations 7

Authors

Yukihide Minoda

Hiroyoshi Iwaki

Mitsuhiko Ikebuchi

Taku Yoshida

Shigekazu Mizokawa

Maki Itokazu

Hiroaki Nakamura

Affiliations

Soon will be listed here.

Abstract

Purpose: Range of motion is a crucial measure of the outcome of total knee arthroplasty. Gap balancing technique and mobile-bearing prosthesis can improve postoperative range of motion. The purpose of this study was to determine the factors that are predictive of the postoperative range of motion.

Methods: A total of 94 knees with varus osteoarthritis were prospectively randomized to receive either a posterior-stabilized mobile-bearing or a posterior-stabilized fixed-bearing prosthesis. All preoperative and postoperative protocols and operative techniques were identical in the two groups. Extension and flexion joint gaps were measured using a tensor device during the operation. Multiple regression analysis was conducted to determine the best predictors of the knee flexion angle 2 years after the operation. The independent variables were type of prosthesis (mobile-bearing or fixed-bearing), difference between flexion and extension joint gaps (mm), age, gender, body mass index (BMI), preoperative and intraoperative knee flexion angles, change in posterior condylar offset, and posterior tilt of the tibial plateau.

Results: The mean difference between flexion and extension joint gaps was 0.8 ± 1.3 (mean ± SD) mm for mobile-bearing and 0.8 ± 1.9 mm for fixed-bearing prosthesis. The mean flexion angle for mobile-bearing and fixed-bearing groups was 120 ± 16° and 116 ± 20° preoperatively (n.s.), 142 ± 9° and 141 ± 12° intraoperatively (n.s.), and 129 ± 10° and 128 ± 13° at 2 years postoperatively (p = 0.773), respectively. Predictors were identified in the following three categories: (1) preoperative flexion angle, (2) intraoperative radiographic flexion angle, and (3) BMI (R = 0.603, p < 0.001).

Conclusions: Mobile-bearing prosthesis and optimal gap balancing did not result in superior postoperative flexion angle. Better preoperative and intraoperative flexion angles and lower BMI were the significant predictors for better postoperative flexion angle.

Level Of Evidence: Therapeutic study, Level I.

Citing Articles

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No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis.

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[Research progress of larger flexion gap than extension gap in total knee arthroplasty].

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No differences between fixed- and mobile-bearing total knee arthroplasty.

Fransen B, van Duijvenbode D, Hoozemans M, Burger B Knee Surg Sports Traumatol Arthrosc. 2016; 25(6):1757-1777.

PMID: 27324479 DOI: 10.1007/s00167-016-4195-x.

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