Range of motion and functional results in three different designs of total knee arthroplasty.
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Published:
Nov 8, 2016
Keywords:
Total knee arthroplasty, high flexion arthroplasty, conventional arthroplasty, range of motion.
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Abstract
Background: The purpose of this comparative study was to analyze functional results and the range of motion of the knee between two groups of patients with total knee arthroplasty using high-flex prosthesis (in two group) and one group using conventional desing.Methods: 64 patients were surgically treated with total knee arthroplasty with Zimmer NexGen®, and 34 patients were surgically treated with high flexión Optetrack® artrhoplasty. After exclusion of patients, 22 patients (group A) were treated with high-flex design Zimmer, 21 patients (group B) were treated with a conventional implant, 25 patients (Group C) with high flex PS Optetrack® arthroplasty. Maximum flexion and extension were evaluated before and after surgery. Functional evaluation was performed with the Knee Society Score , the Western Ontario and McMaster Universities osteoarthritis index , and an analogous visual scale.Results: Mean post-surgical maximum flexion in group A increased from 99° to 113º with an average increase of 14º, in group B from 106° to 118º with an average gain of 12º, and in the group C from 110 to 111° with an avarege increase of 1°. Functional results assessed with KSS and WOMAC showed improvements in all three groups Conclusion: The funtional and radiographic outcomes were favorable in the three desings artrhoplasty. This study suggests that there are no significant differences in the final flexion, KSS score and the funtional womac socre between the first tow desings, however together are significant superior to the third group after one year of follow up.
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How to Cite
Bonifacio, J. P., Costa Paz, M., Yacuzzi, C. H., & Carbo, L. (2016). Range of motion and functional results in three different designs of total knee arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(4), 264-273. https://doi.org/10.15417/596
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Clinical Research
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References
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5. Banks S, Bellemans J, Nozaki H, Whiteside LA, Harman, M Hodge WA. Knee motions during maximum flexion in fixed and mobile bearing arthroplasties. Clin Orthop 2003; 410:131.
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14. Bellemans J, Banks S, Victor J, Vandenneucker A, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. J Bone Joint Surg Br 2002; 84-B:50-3.
15. Massin P, Gournay A.Optimization of the posterior condylar offset, tibial slope and condylar roll-back in total knee arthroplasty. J Arthroplasty 2006; 21:889-96.
16. Most E, Sultan PG, Park SE, Papannagari R. Li G. Tibiofemoral contact behaviour is improved in high-flexion cruciate retaining TKA. Clin Orthop 2006; 452:59-64.
17. Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD. Kneeling kinematics after total knee arthroplasty: anterior-posterior contact position of a standard and a high-flex tibial insert design. J Arthroplasty 2007; 22:160-5.
18. Huang HT, Su JY, Wang GJ. The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up. J Arthroplasty 2005; 20:674 9.
19. Huddleston JI, Scarborough DM, Goldvasser D, Freiberg A, Malchou H. How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?. Clin Orthop Relat Res 2009; 467:1898–1906.
20. Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses: a prospective, randomized study. J Bone Joint Surg Am 2005; 87-A:1470-5.
21. Kim YH, Choi Y, Oh-Ryong K and Kim JS. 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; 91:753-760.
22. Laskin RS. The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 2007; 30(Suppl):86-8.
23. McCalden RW, MacDonald SJ, Bourne RB, Marr JT. A randomized controlled trial comparing “high-flex” vs “standard” posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty. J Arthroplasty 2009; 24(Suppl):33-8.
24. Mehin R, Burnett RS, Brasher PMA. Does the new generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis. J Bone Joint Surg Br 2010; 92-B:1429-34.
25. Ng FY, Wong HL, Yau WP, Chiu KY, Tang WM. Comparison of range of motion after standard and high-flexion posterior stabilised total knee replacement. Int Orthop 2008; 32:795-8.
26. Nutton RW, Van der Linden ML, Rowe PJ, Gaston P, Wade FA. 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 2008; 90-B:37-42.
27. Seon JK, Park SJ, Lee KB, Yoon TR, Kozanek M, Song EK. Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am 2009; 91A:672-9.
28. Weeden SH, Schmidt R. A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty 2007; 22:349-52.
29. Gandhi R, Tso P, Davey JR, Mahomed NN. High-flexion implants in primary total knee arthroplasty: a meta-analysis. Knee 2009; 16(1): 14–17.
30. Luo SX, Su W, Zhao JM, Sha K, Wei QJ, Li XF. High-flexion vs. conventional prostheses total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26(6): 847–54.
31. Wang Z, Wie M, Zhang Q, Zhang Z, Cui Y. Comparasion of High-Flexion and Conventional Implants in Total Knee Arthroplasty: A Meta-Analysis. Med Sci Monit 2015; 21:1679-1686.
32. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop 1989 ;(248):13-14.
33. Bellamy N, Buchanan WW. A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 1986; 5:231-41.
34. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting Range of Motion After Total Knee Arthroplasty. Journal of Bone Joint Surg. Am 2003; 85-A 1278-1285.
35. Kawamura H, Bourne RB. Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 2001; 6(3): 248–52.
36. Dennis DA, Komistek RD, Stiehl JB,Walker SA, Dennis KN. Range of motion after total knee arthroplasty The effect of implant design and weight-bearing conditions. J Arthroplasty 1998; 13(7): 748–52.
37. Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 2009; 17(5):491–98.
38. Murphy M, Journeaux S, Russell T. “High-Flexion Total Knee Arthroplasty: A Systematic Review.” International Orthopaedics 2009: 887–893.
39. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilized-flex total knee replacement. J Bone Joint Surg Br 2007; 89:1457–1461.
40. Ranawat CS. Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res 2003; 416:174–176.
41. Park KK, Chang CB, Kang YG, Seong SC, Kim TK. Correlation of maximum flexion with clinical outcome after total knee replacement in Asian patients. J Bone Joint Surg Br 2007; 89:604– 608.
42. Malik A, Salas A, Ben Ari J, Ma Y, González Della Valle A. Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts. International Orthopaedics (SICOT) 2010; 34:965–972.
2. M.A. Kelly, H.D Clarke. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop 2002; 404: 51–57.
3. Ranawat CS , Flyn WF, Saddler S, Hansraj KK, Maynard MJ. Long term results of the total condylar knee arthroplasty: a 15 year survivorship study. Clin Orthop 1993; 286: 94–102.
4. Insall JN, Lachiewicz PF, Burstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two- to four-year clinical experience. J Bone Joint Surg Am 1982; 64A: 1317.
5. Banks S, Bellemans J, Nozaki H, Whiteside LA, Harman, M Hodge WA. Knee motions during maximum flexion in fixed and mobile bearing arthroplasties. Clin Orthop 2003; 410:131.
6. Mizner RL, Petterson SC, Stevens JE, Axe MJ, Snyder-Macker L. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol 2005; 32:1533-9.
7. Parent E, Moffet H. Preoperative predictors of locomotor ability two months after total knee arthroplasty for severe osteoarthritis. Arthritis Rheum 2003; 49:36-50.
8. Maohomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Foseel AH, Katz JN. The importance of patient expectations in prediction functional outcomes after total joint arthroplasty. J Rheumatol 2002; 29:1273-9.
9. Bin SI, Nam TS. Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc 2007; 15:350-5.
10. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71:262.
11. Report on the Ontario Joint Replacement Registry. Edited; 2006 [Toronto, Ontario, Canada].
12. Sultan PG, Most E, Schule S, Li G, Rubash HE. Optimizing flexion after total knee arthroplasty: advances in prosthetic design. Clin Orthop 2003; 416:167-73.
13. Argenson JN, Komistek RD, Mahfouz M, Walker SA, Aubaniac JM, Dennis DA. A high flexion total knee arthroplasty design replicates healthy knee motion. Clin Orthop 2004; 428:174-9.
14. Bellemans J, Banks S, Victor J, Vandenneucker A, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. J Bone Joint Surg Br 2002; 84-B:50-3.
15. Massin P, Gournay A.Optimization of the posterior condylar offset, tibial slope and condylar roll-back in total knee arthroplasty. J Arthroplasty 2006; 21:889-96.
16. Most E, Sultan PG, Park SE, Papannagari R. Li G. Tibiofemoral contact behaviour is improved in high-flexion cruciate retaining TKA. Clin Orthop 2006; 452:59-64.
17. Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD. Kneeling kinematics after total knee arthroplasty: anterior-posterior contact position of a standard and a high-flex tibial insert design. J Arthroplasty 2007; 22:160-5.
18. Huang HT, Su JY, Wang GJ. The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up. J Arthroplasty 2005; 20:674 9.
19. Huddleston JI, Scarborough DM, Goldvasser D, Freiberg A, Malchou H. How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?. Clin Orthop Relat Res 2009; 467:1898–1906.
20. Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses: a prospective, randomized study. J Bone Joint Surg Am 2005; 87-A:1470-5.
21. Kim YH, Choi Y, Oh-Ryong K and Kim JS. 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; 91:753-760.
22. Laskin RS. The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 2007; 30(Suppl):86-8.
23. McCalden RW, MacDonald SJ, Bourne RB, Marr JT. A randomized controlled trial comparing “high-flex” vs “standard” posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty. J Arthroplasty 2009; 24(Suppl):33-8.
24. Mehin R, Burnett RS, Brasher PMA. Does the new generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis. J Bone Joint Surg Br 2010; 92-B:1429-34.
25. Ng FY, Wong HL, Yau WP, Chiu KY, Tang WM. Comparison of range of motion after standard and high-flexion posterior stabilised total knee replacement. Int Orthop 2008; 32:795-8.
26. Nutton RW, Van der Linden ML, Rowe PJ, Gaston P, Wade FA. 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 2008; 90-B:37-42.
27. Seon JK, Park SJ, Lee KB, Yoon TR, Kozanek M, Song EK. Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am 2009; 91A:672-9.
28. Weeden SH, Schmidt R. A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty 2007; 22:349-52.
29. Gandhi R, Tso P, Davey JR, Mahomed NN. High-flexion implants in primary total knee arthroplasty: a meta-analysis. Knee 2009; 16(1): 14–17.
30. Luo SX, Su W, Zhao JM, Sha K, Wei QJ, Li XF. High-flexion vs. conventional prostheses total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26(6): 847–54.
31. Wang Z, Wie M, Zhang Q, Zhang Z, Cui Y. Comparasion of High-Flexion and Conventional Implants in Total Knee Arthroplasty: A Meta-Analysis. Med Sci Monit 2015; 21:1679-1686.
32. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop 1989 ;(248):13-14.
33. Bellamy N, Buchanan WW. A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 1986; 5:231-41.
34. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting Range of Motion After Total Knee Arthroplasty. Journal of Bone Joint Surg. Am 2003; 85-A 1278-1285.
35. Kawamura H, Bourne RB. Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 2001; 6(3): 248–52.
36. Dennis DA, Komistek RD, Stiehl JB,Walker SA, Dennis KN. Range of motion after total knee arthroplasty The effect of implant design and weight-bearing conditions. J Arthroplasty 1998; 13(7): 748–52.
37. Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 2009; 17(5):491–98.
38. Murphy M, Journeaux S, Russell T. “High-Flexion Total Knee Arthroplasty: A Systematic Review.” International Orthopaedics 2009: 887–893.
39. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilized-flex total knee replacement. J Bone Joint Surg Br 2007; 89:1457–1461.
40. Ranawat CS. Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res 2003; 416:174–176.
41. Park KK, Chang CB, Kang YG, Seong SC, Kim TK. Correlation of maximum flexion with clinical outcome after total knee replacement in Asian patients. J Bone Joint Surg Br 2007; 89:604– 608.
42. Malik A, Salas A, Ben Ari J, Ma Y, González Della Valle A. Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts. International Orthopaedics (SICOT) 2010; 34:965–972.