Skip to main content
Top
Published in: International Orthopaedics 10/2014

01-10-2014 | Original Paper

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

Authors: Maxime L. Mencière, Jean-Alain Epinette, Antoine Gabrion, Damien Arnalsteen, Patrice Mertl

Published in: International Orthopaedics | Issue 10/2014

Login to get access

Abstract

Purpose

A full range of motion after total knee arthroplasty has become more and more requested by our patients, leading to novel designs of knee implants, the so-called “hyperflex” knees. The aim of the present study was to confirm whether or not hyperflexion of operated knees really improves the patients’ quality of life.

Methods

A retrospective comparative case–control study has been carried out to compare clinical results shown in two types of knee prosthesis, from two homogeneous paired groups of patients including 45 cases of a “hyperflex” model (RP-F), while the control group consisted of 43 cases of a “regular design” model (Triathlon) in terms of expected postoperative flexion.

Results

The hyperflex group demonstrated significant higher mean values of passive flexion at 119.9° in the RP-F group versus 111.1° in the Triathlon group. However, global results in the “regular” control group were significantly better than the “hyperflex” study group, in both IKS knee and functional scores at 84.4 points (RP-F) vs. 89.8 points (Triathlon), and 84.6 points (RP-F) vs. 89.5 points (Triathlon), respectively. Moreover, the self-administered KOOS questionnaire was significantly in favor of the control group, with 73.5 points in RP-F knees versus 86.0 points for Triathlon knees at global KOOS postoperative scores.

Conclusion

The quality of life of operated patients after TKA obviously would be considered as the main priority, which was better obtained by a “regular design” in our study. Hence “high flexion” cannot be considered as an absolute target when choosing a model for total knee arthroplasty.
Literature
1.
go back to reference Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg (Br) 84:50–53CrossRef Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg (Br) 84:50–53CrossRef
2.
go back to reference 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 15:350–355PubMedCrossRef 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 15:350–355PubMedCrossRef
3.
go back to reference Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg (Br) 54:61–76 Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg (Br) 54:61–76
4.
go back to reference Cook LE, Klika AK, Szubski CR, Rosneck J, Molloy R, Barsoum WK (2012) Functional outcomes used to compare single radius and multiradius of curvature designs in total knee arthroplasty. J Knee Surg 25:249–253PubMedCrossRef Cook LE, Klika AK, Szubski CR, Rosneck J, Molloy R, Barsoum WK (2012) Functional outcomes used to compare single radius and multiradius of curvature designs in total knee arthroplasty. J Knee Surg 25:249–253PubMedCrossRef
5.
go back to reference Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN (1998) Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty 13:748–752PubMedCrossRef Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN (1998) Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty 13:748–752PubMedCrossRef
6.
go back to reference Devers BN, Conditt MA, Jamieson ML, Driscoll MD, Noble PC, Parsley BS (2011) Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty? J Arthroplasty 26:178–186PubMedCrossRef Devers BN, Conditt MA, Jamieson ML, Driscoll MD, Noble PC, Parsley BS (2011) Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty? J Arthroplasty 26:178–186PubMedCrossRef
7.
go back to reference Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ (2004) Measuring flexion in knee arthroplasty patients. J Arthroplasty 19:369–372PubMedCrossRef Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ (2004) Measuring flexion in knee arthroplasty patients. J Arthroplasty 19:369–372PubMedCrossRef
8.
go back to reference Gandhi R, Tso P, Davey JR, Mahomed NN (2009) High-flexion implants in primary total knee arthroplasty: a meta-analysis. Knee 16:14–17PubMedCrossRef Gandhi R, Tso P, Davey JR, Mahomed NN (2009) High-flexion implants in primary total knee arthroplasty: a meta-analysis. Knee 16:14–17PubMedCrossRef
9.
go back to reference Gupta SK, Ranawat AS, Shah V, Zikria BA, Zikria JF, Ranawat CS (2006) The P.F.C. sigma RP-F TKA designed for improved performance: a matched-pair study. Orthopedics 29:S49–S52PubMed Gupta SK, Ranawat AS, Shah V, Zikria BA, Zikria JF, Ranawat CS (2006) The P.F.C. sigma RP-F TKA designed for improved performance: a matched-pair study. Orthopedics 29:S49–S52PubMed
10.
go back to reference Hall J, Copp SN, Adelson WS, D’Lima DD, Colwell CW Jr (2008) Extensor mechanism function in single-radius vs multiradius femoral components for total knee arthroplasty. J Arthroplasty 23:216–219PubMedCrossRef Hall J, Copp SN, Adelson WS, D’Lima DD, Colwell CW Jr (2008) Extensor mechanism function in single-radius vs multiradius femoral components for total knee arthroplasty. J Arthroplasty 23:216–219PubMedCrossRef
11.
go back to reference Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg (Br) 75:950–955 Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg (Br) 75:950–955
12.
go back to reference 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 20:674–679PubMedCrossRef 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 20:674–679PubMedCrossRef
13.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed
14.
go back to reference Kurita M, Tomita T, Yamazaki T, Fujii M, Futai K, Shimizu N, Yoshikawa H, Sugamoto K (2012) In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. Int Orthop 36:2465–2471PubMedCrossRefPubMedCentral Kurita M, Tomita T, Yamazaki T, Fujii M, Futai K, Shimizu N, Yoshikawa H, Sugamoto K (2012) In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. Int Orthop 36:2465–2471PubMedCrossRefPubMedCentral
15.
go back to reference Lamb SE, Frost H (2003) Recovery of mobility after knee arthroplasty: expected rates and influencing factors. J Arthroplasty 18:575–582PubMedCrossRef Lamb SE, Frost H (2003) Recovery of mobility after knee arthroplasty: expected rates and influencing factors. J Arthroplasty 18:575–582PubMedCrossRef
16.
go back to reference Laskin RS (2007) The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 30:86–88PubMed Laskin RS (2007) The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 30:86–88PubMed
17.
go back to reference Lizaur A, Marco L, Cebrian R (1997) Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J Bone Joint Surg (Br) 79:626–629CrossRef Lizaur A, Marco L, Cebrian R (1997) Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J Bone Joint Surg (Br) 79:626–629CrossRef
18.
go back to reference Massin P, Dupuy F-R, Khlifi H, Fornasieri C, De Polignac T, Schifrine P, Fareng C, Mertl P (2010) Does hyperflex total knee design improve postoperative active flexion? Orthop Traumatol Surg Res 96:376–380PubMedCrossRef Massin P, Dupuy F-R, Khlifi H, Fornasieri C, De Polignac T, Schifrine P, Fareng C, Mertl P (2010) Does hyperflex total knee design improve postoperative active flexion? Orthop Traumatol Surg Res 96:376–380PubMedCrossRef
19.
go back to reference Matsuzaki T, Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kawakami Y, Ishida K, Oka S, Kuroda R, Kurosaka M (2013) Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty. Int Orthop 37:803–808PubMedCrossRefPubMedCentral Matsuzaki T, Matsumoto T, Muratsu H, Kubo S, Matsushita T, Kawakami Y, Ishida K, Oka S, Kuroda R, Kurosaka M (2013) Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty. Int Orthop 37:803–808PubMedCrossRefPubMedCentral
20.
go back to reference Meneghini RM, Pierson JL, Bagsby D, Ziemba-Davis M, Berend ME, Ritter MA (2007) Is there a functional benefit to obtaining high flexion after total knee arthroplasty? J Arthroplasty 22:43–46PubMedCrossRef Meneghini RM, Pierson JL, Bagsby D, Ziemba-Davis M, Berend ME, Ritter MA (2007) Is there a functional benefit to obtaining high flexion after total knee arthroplasty? J Arthroplasty 22:43–46PubMedCrossRef
21.
go back to reference Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson J-N, Roos EM (2008) Cross-cultural adaptation and validation of the French version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in knee osteoarthritis patients. Osteoarthr Cartil 16:423–428PubMedCrossRef Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson J-N, Roos EM (2008) Cross-cultural adaptation and validation of the French version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in knee osteoarthritis patients. Osteoarthr Cartil 16:423–428PubMedCrossRef
22.
go back to reference Ranawat AS, Gupta SK, Ranawat CS (2006) The P.F.C. sigma RP-F total knee arthroplasty: designed for improved performance. Orthopedics 29:S28–S29PubMed Ranawat AS, Gupta SK, Ranawat CS (2006) The P.F.C. sigma RP-F total knee arthroplasty: designed for improved performance. Orthopedics 29:S28–S29PubMed
23.
go back to reference 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:1278–1285PubMed 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:1278–1285PubMed
24.
go back to reference Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS), development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMedCrossRef Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS), development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMedCrossRef
25.
go back to reference Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP for the STROBE Initiative (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Internist (Berl) 49(6):688–693 Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP for the STROBE Initiative (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Internist (Berl) 49(6):688–693
26.
go back to reference Weeden SH, Schmidt R (2007) A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty 22:349–352PubMedCrossRef Weeden SH, Schmidt R (2007) A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty 22:349–352PubMedCrossRef
Metadata
Title
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
Authors
Maxime L. Mencière
Jean-Alain Epinette
Antoine Gabrion
Damien Arnalsteen
Patrice Mertl
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 10/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-014-2372-4

Other articles of this Issue 10/2014

International Orthopaedics 10/2014 Go to the issue