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No difference between standard and high flexion cruciate retaining total knee arthroplasty: a prospective randomised controlled study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this prospective, randomised, double-blind study was to test the hypotheses that patients with high-flexion total knee arthroplasty (TKA) have (1) a wider/greater range of motion (ROM) post-operatively and (2) higher levels of knee society score (KSS) and WOMAC score post-operatively compared to standard TKA.

Methods

In this study, 28 high flexion with 31 standard TKAs were compared. We measured ROM, pre-operatively, on day 3, 7, 28, and after 6 and 36 months post-operatively as well as KSS and WOMAC score pre-operatively, on day 28 and after 6 and 36 months post-operatively.

Results

No statistically significant differences were found between both groups with regard to the target parameters. The mean ROM was 113° (range 80°–140°, SD 13.4°) in the control group (standard TKA) and 117° (range 90°–140°, SD 12.3) in the study group (high-flexion TKA) at 36 months follow-up [p = not significant (n.s.)]. The KSS pre-operatively was 38.2 (range 8–64, SD 15.8) in the control group and 45.9 (range 8–74, SD 16.0) in the study group (n.s.) increasing to 157.6 in the control group and 156.7 in the study group (p = n.s) at 36 months follow-up.

Conclusion

This study could not confirm significant benefits of high-flexion TKA compared to standard TKA with regard to ROM and higher levels of KSS and WOMAC score.

Level of evidence

I.

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References

  1. Bajammal SS, Petruccelli D, Adili A, Winemaker M, de Beer J (2008) Can a change in implant articular geometry affect postoperative range of movement patients undergoing primary TKA for osteoarthritis? J Bone Joint Surg Br 90-B:123

    Google Scholar 

  2. Bellamy N, Campbell J, Stevens J, Pilch L, Stewart C, Mahmood Z (1997) Validation study of a computerized version of the Western Ontario and McMaster Universities VA3.0 Osteoarthritis Index. J Rheumatol 24:2413–2415

    CAS  PubMed  Google Scholar 

  3. Benoist M (2009) The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2008. Eur Spine J 18:1–12

    Article  PubMed Central  Google Scholar 

  4. Bin SI, Nam TS (2007) Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc 15:350–355

    Article  PubMed  Google Scholar 

  5. Cho S-D, Youm Y-S, Park K-B (2011) Three- to six-year follow-up results after high-flexion total knee arthroplasty: can we allow passive deep knee bending? Knee Surg Sports Traumatol Arthrosc 19:899–903

    Article  PubMed  Google Scholar 

  6. Gandhi R, Tso P, Davey JR, Mahomed NN (2009) High-flexion implants in primary total knee arthroplasty: a meta-analysis. Knee 16:14–17

    Article  PubMed  Google Scholar 

  7. Guild GN III, Labib SA (2014) Clinical outcomes in high flexion total knee arthroplasty were not superior to standard posterior stabilized total knee arthroplasty. a multicenter, prospective, randomized study. J Arthroplasty 29:530–534

    Article  PubMed  Google Scholar 

  8. Huang H-T, Su JY, Wang G-J (2005) The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up. J Arthroplasty 20:674–679

    Article  PubMed  Google Scholar 

  9. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  10. Jain S, Pathak AC, Kanniyan K, Kulkarni S, Tawar S, Mane P (2013) High-flexion posterior-stabilized total knee prosthesis: is it worth the hype? Knee Surg Relat Res 25:100

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kawamura H, Bourne RB (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6:248–252

    Article  CAS  PubMed  Google Scholar 

  12. Kim Y-H, Sohn K-S, Kim J-S (2005) Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study. J Bone Joint Surg 87:1470–1475

    Article  PubMed  Google Scholar 

  13. Laskin RS (2007) The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 30:86–88

    PubMed  Google Scholar 

  14. Laubenthal KN, Smidt GL, Kettelkamp DB (1972) A quantitative analysis of knee motion during activities of daily living. Phys Ther 52:34–43

    CAS  PubMed  Google Scholar 

  15. Lützner J, Hartmann A, Lützner C, Kirschner S (2014) Is range of motion after cruciate-retaining total knee arthroplasty influenced by prosthesis design? A prospective randomized trial. J Arthroplasty 29(5):961–965

    Article  PubMed  Google Scholar 

  16. McCalden RW, MacDonald SJ, Bourne RB, Marr JT (2009) A randomized controlled trial comparing “high-flex” vs “standard” posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty. J Arthroplasty 24:33–38

    Article  PubMed  Google Scholar 

  17. Mehin R, Burnett RS, Brasher PMA (2010) Does the new generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis. J Bone Joint Surg Br 92:1429–1434

    Article  CAS  PubMed  Google Scholar 

  18. Mulholland SJ, Wyss UP (2001) Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants. Int J Rehabil Res 24:191–198

    Article  CAS  PubMed  Google Scholar 

  19. Namba RS, Inacio MCS, Cafri G (2014) Increased risk of revision for high flexion total knee replacement with thicker tibial liners. Bone Joint J 96-B:217–223

    Article  CAS  PubMed  Google Scholar 

  20. Nutton RW, van der Linden ML, Rowe PJ, Gaston P, Wade FA (2008) 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 90:37–42

    Article  CAS  PubMed  Google Scholar 

  21. Radetzki F, Wienke A, Mendel T, Gutteck N, Delank K-S, Wohlrab D (2013) High flex total knee arthroplasty—a prospective, randomized study with results after 10 years. Acta Orthop Belg 79:536–540

    PubMed  Google Scholar 

  22. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME (2003) Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 85-A:1278–1285

    PubMed  Google Scholar 

  23. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L (2000) Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 71:262–267

    Article  CAS  PubMed  Google Scholar 

  24. Rowe PJ, Myles CM, Walker C, Nutton R (2000) 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 12:143–155

    Article  CAS  PubMed  Google Scholar 

  25. Schroer WC, Stormont DM, Pietrzak WS (2014) Seven-year survivorship and functional outcomes of the high-flexion vanguard complete knee system. J Arthroplasty 29:61–65

    Article  PubMed  Google Scholar 

  26. Weeden SH, Schmidt R (2007) A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty 22:349–352

    Article  PubMed  Google Scholar 

  27. Wohlrab D, Ditl J, Herrschelmann R, Schietsch U, Hein W, Hube R (2005) Does the NexGen LPS flex mobile knee prosthesis offer advantages compared to the NexGen LPS? A comparison of clinical and radiological results. Z Orthop Ihre Grenzgeb 143:567–572

    Article  CAS  PubMed  Google Scholar 

  28. Zelle J, van de Groes SAW, de Waal Malefijt MC, Verdonschot N (2013) Femoral loosening of high-flexion total knee arthroplasty: the effect of posterior cruciate ligament retention and bone quality reduction. Med Eng Phys 36(3):318–324

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany

    Hans Robert Springorum, Günther Maderbacher, Benjamin Craiovan, Clemens Baier, Joachim Grifka & Armin Keshmiri

  2. Department of Orthopaedic Surgery, University of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

    Christian Lüring

Authors
  1. Hans Robert Springorum
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  2. Günther Maderbacher
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  3. Benjamin Craiovan
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  4. Christian Lüring
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  6. Joachim Grifka
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  7. Armin Keshmiri
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Correspondence to Armin Keshmiri.

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Springorum, H.R., Maderbacher, G., Craiovan, B. et al. No difference between standard and high flexion cruciate retaining total knee arthroplasty: a prospective randomised controlled study. Knee Surg Sports Traumatol Arthrosc 23, 1591–1597 (2015). https://doi.org/10.1007/s00167-014-3082-6

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  • DOI: https://doi.org/10.1007/s00167-014-3082-6

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