Clinical Advantages of Gradually Reducing Radius Versus Multi-radius Total Knee Arthroplasty: a Noninferiority Randomized Trial

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2023 Jan 26

PMID 36703203

Authors

Sakkadech Limmahakhun

Anuchit Chaiamporn

Kasisin Klunklin

Warakorn Jingjit

Affiliations

Soon will be listed here.

Abstract

Background: The rationale for gradually reducing radius (GR) femoral component aims to prevent flexion instability by gradually change the center of femoral rotation, unlike a discrete change by the multi-radius (MR) which is more common for most of total knee arthroplasties (TKA). However, no strong evidence has been reported the clinical significance of the GR design.

Methods: This patient-blinded, parallel, non-inferiority trial conducted between January 2018-December 2020. Patients with knee osteoarthritis consented for cruciate retaining TKA were randomly allocated to a GR or MR group. Primary outcome measures were knee functions at postoperative 6 and 12 months using the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measures were performance-based tests (30-s chair stand test, 40-m fast paced walk test, and 3-m timed up and go test), and knee motions.

Results: Sixty patients were enrolled and randomized; GR (n = 30) and MR (n = 30) group. The changes of KOOS at 6 and 12 months from baseline showed clinical meaningful for both GR and MR group. At 6 and 12 months postoperatively, there was no significant difference between both groups in all KOOS subscales. The length of stay was not different between GR and MR group (5.93 ± 1.44 vs 6.17 ± 1.86 days, p = 0.59). Patients on both groups presented similar performance-based tests. However, the improvement in degrees of knee motion for the GR group was significantly greater than the MR group (34.67 ± 12.52 vs 23.67 ± 12.59, p = 0.001).

Conclusion: GR was noninferiority to MR for the functional outcomes and performances after TKA. The GR femoral component gave more knee motions than did the MR prostheses.

Level Of Evidence: Level I, therapeutic study.

Citing Articles

Correction: Clinical advantages of gradually reducing radius versus multi‑radius total knee arthroplasty: a noninferiority randomized trial.

Limmahakhun S, Chaiamporn A, Klunklin K, Jingjit W BMC Musculoskelet Disord. 2023; 24(1):892.

PMID: 37974139 PMC: 10652469. DOI: 10.1186/s12891-023-07017-1.

References

Luo Z, Luo Z, Wang H, Xiao Q, Pei F, Zhou Z . Long-term results of total knee arthroplasty with single-radius versus multi-radius posterior-stabilized prostheses. J Orthop Surg Res. 2019; 14(1):139. PMC: 6521522. DOI: 10.1186/s13018-019-1183-0. View

Victor J, Banks S, Bellemans J . Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br. 2005; 87(5):646-55. DOI: 10.1302/0301-620X.87B5.15602. View

Baker P, van der Meulen J, Lewsey J, Gregg P . The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007; 89(7):893-900. DOI: 10.1302/0301-620X.89B7.19091. View

Bourne R, Chesworth B, Davis A, Mahomed N, Charron K . Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res. 2009; 468(1):57-63. PMC: 2795819. DOI: 10.1007/s11999-009-1119-9. View

Bohannon R . Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing. 1997; 26(1):15-9. DOI: 10.1093/ageing/26.1.15. View

Hung M, Bounsanga J, Voss M, Saltzman C . Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and.... World J Orthop. 2018; 9(3):41-49. PMC: 5859199. DOI: 10.5312/wjo.v9.i3.41. View

Ushio T, Hamai S, Okazaki K, Gondo H, Ikebe S, Higaki H . Gradual-radius femoral component with s-curve post-cam provides stable kinematics at mid-flexion after total knee arthroplasty. J Orthop Sci. 2021; 27(3):665-671. DOI: 10.1016/j.jos.2021.02.015. View

Shumway-Cook A, Brauer S, Woollacott M . Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000; 80(9):896-903. View

Liu S, Long H, Zhang Y, Ma B, Li Z . Meta-Analysis of Outcomes of a Single-Radius Versus Multi-Radius Femoral Design in Total Knee Arthroplasty. J Arthroplasty. 2015; 31(3):646-54. DOI: 10.1016/j.arth.2015.10.017. View

10.

Clary C, Fitzpatrick C, Maletsky L, Rullkoetter P . The influence of total knee arthroplasty geometry on mid-flexion stability: an experimental and finite element study. J Biomech. 2013; 46(7):1351-7. DOI: 10.1016/j.jbiomech.2013.01.025. View

11.

Ng J, Bloch B, James P . Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty. EFORT Open Rev. 2019; 4(8):519-524. PMC: 6719604. DOI: 10.1302/2058-5241.4.180083. View

12.

Frankel V, Burstein A, Brooks D . Biomechanics of internal derangement of the knee. Pathomechanics as determined by analysis of the instant centers of motion. J Bone Joint Surg Am. 1971; 53(5):945-62. View

13.

Ranawat C, White P, West S, Ranawat A . Clinical and Radiographic Results of Attune and PFC Sigma Knee Designs at 2-Year Follow-Up: A Prospective Matched-Pair Analysis. J Arthroplasty. 2016; 32(2):431-436. DOI: 10.1016/j.arth.2016.07.021. View

14.

White P, Turcan S, Satalich J, Ranawat A, Ranawat C . Clinical Outcomes of a Modern Total Knee Arthroplasty Prosthesis Compared to Its Predecessor at 5-Year Follow-Up: Matched Pair Analysis. J Arthroplasty. 2020; 35(11):3150-3155. DOI: 10.1016/j.arth.2020.06.024. View

15.

Jones C, Rikli R, Beam W . A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999; 70(2):113-9. DOI: 10.1080/02701367.1999.10608028. View

16.

Menciere M, Epinette J, Gabrion A, Arnalsteen D, Mertl P . Does high flexion after total knee replacement really improve our patients' quality of life at a short-term follow-up? : a comparative case-control study with hyperflex PFC Sigma versus a Triathlon knee series. Int Orthop. 2014; 38(10):2079-86. DOI: 10.1007/s00264-014-2372-4. View

17.

Pfitzner T, Moewis P, Stein P, Boeth H, Trepczynski A, von Roth P . Modifications of femoral component design in multi-radius total knee arthroplasty lead to higher lateral posterior femoro-tibial translation. Knee Surg Sports Traumatol Arthrosc. 2017; 26(6):1645-1655. DOI: 10.1007/s00167-017-4622-7. View

18.

Kennedy J, Fowler P . Medial and anterior instability of the knee. An anatomical and clinical study using stress machines. J Bone Joint Surg Am. 1971; 53(7):1257-70. View

19.

Takagi H, Soshi Asai , Sato A, Maekawa M, Kawashima H, Kanzaki K . Case series report of navigation-based knee kinematics in total knee arthroplasty with a gradually reducing femoral radius design. Ann Med Surg (Lond). 2017; 17:33-37. PMC: 5377241. DOI: 10.1016/j.amsu.2017.03.032. View

20.

Carey B, Harty J . A comparison of clinical- and patient-reported outcomes of the cemented ATTUNE and PFC sigma fixed bearing cruciate sacrificing knee systems in patients who underwent total knee replacement with both prostheses in opposite knees. J Orthop Surg Res. 2018; 13(1):54. PMC: 5856217. DOI: 10.1186/s13018-018-0757-6. View