Top

International Orthopaedics

Published in:

01-09-2012 | Original Paper

Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up

Authors: Sebastien Lustig, Corey J. Scholes, Tim J. Stegeman, Sam Oussedik, Myles R. J. Coolican, David A. Parker

Published in: International Orthopaedics | Issue 9/2012

Abstract

Purpose

Flexion contracture has been shown to impair function and reduce satisfaction following total knee arthroplasty (TKA). The aim of this study was to identify modifiable intra-operative variables that predict post-TKA knee extension.

Methods

Data was collected prospectively on 95 patients undergoing total knee arthroplasty, including pre-operative assessment, intra-operative computer assisted surgery (CAS) measurements and functional outcome including range of motion at one year. Patients were divided into two groups: those with mild flexion contracture (> 5°) at the one-year follow-up and those achieving full extension.

Results

The sagittal orientation of the distal femoral cut differed significantly between groups at the one-year follow-up (p = 0.014). Sagittal alignment of greater than 3.5° from the mechanical axis was shown to increase the relative risk of a mild flexion contracture at one-year follow-up by 2.9 times, independent of other variables.

Conclusion

Increasing the sagittal alignment of the distal femoral cut more than 3.5° from the mechanical axis is an independent risk factor for clinically detectable flexion contracture one year from index procedure.

Begg RK, Sparrow WA (2006) Ageing effects on knee and ankle joint angles at key events and phases of the gait cycle. J Med Eng Technol 30(6):382–389PubMedCrossRef

Dixon MC, Brown RR, Parsch D, Scott RD (2005) Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years. J Bone Joint Surg Am 87(3):598–603PubMedCrossRef

Scuderi GR, Kochhar T (2007) Management of flexion contracture in total knee arthroplasty. J Arthroplasty 22(4 Suppl 1):20–24PubMedCrossRef

Ritter MA, Lutgring JD, Davis KE, Berend ME, Pierson JL, Meneghini RM (2007) The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty 22(8):1092–1096PubMedCrossRef

Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y (2010) Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J Arthroplasty 25(2):225–229PubMedCrossRef

Casino D, Zaffagnini S, Martelli S, Lopomo N, Bignozzi S, Iacono F, Russo A, Marcacci M (2009) Intraoperative evaluation of total knee replacement: kinematic assessment with a navigation system. Knee Surg Sports Traumatol Arthrosc 17(4):369–373PubMedCrossRef

Seon JK, Park SJ, Lee KB, Li G, Kozanek M, Song EK (2009) Functional comparison of total knee arthroplasty performed with and without a navigation system. Int Orthop 33(4):987–990PubMedCrossRef

Luring C, Oczipka F, Perlick L, Tingart M, Grifka J, Bathis H (2009) Two year follow-up comparing computer assisted versus freehand TKR on joint stability, muscular function and patients satisfaction. Knee Surg Sports Traumatol Arthrosc 17(3):228–232PubMedCrossRef

Kawamura H, Bourne RB (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sc 6(3):248–252CrossRef

10.

Higuchi H, Hatayama K, Shimizu M, Kobayashi A, Kobayashi T, Takagishi K (2009) Relationship between joint gap difference and range of motion in total knee arthroplasty: a prospective randomised study between different platforms. Int Orthop 33(4):997–1000PubMedCrossRef

11.

Klein GR, Restrepo C, Hozack WJ (2006) The effect of knee component design changes on range of motion evaluation in vivo by a computerized navigation system. J Arthroplasty 21(5):623–627PubMedCrossRef

12.

Lam LO, Swift S, Shakespeare D (2003) Fixed flexion deformity and flexion after knee arthroplasty. What happens in the first 12 months after surgery and can a poor outcome be predicted? Knee 10(2):181–185PubMedCrossRef

13.

Bellemans J, Vandenneucker H, Victor J, Vanlauwe J (2006) Flexion contracture in total knee arthroplasty. Clin Orthop Relat Res 452:78–82PubMedCrossRef

14.

Ferber R, Osternig L, Gravelle D (2002) Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. J Electromyogr Kinesiol 12(5):391–397PubMedCrossRef

15.

Campbell DG, Johnson LJ, West SC (2006) Multiparameter quantitative computer-assisted tomography assessment of unicompartmental knee arthroplasties. ANZ J Surg 76(9):782–787PubMedCrossRef

16.

Kaya Bicer E, Servien E, Lustig S, Demey G, Ait Si Selmi T, Neyret P (2010) Sagittal flexion angle of the femoral component in unicompartmental knee arthroplasty: is it same for both medial and lateral UKAs? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 18(7):928–933CrossRef

17.

Muller PE, Pellengahr C, Witt M, Kircher J, Refior HJ, Jansson V (2004) Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty 19(3):296–301PubMedCrossRef

18.

Gallie PA, Davis ET, Macgroarty K, Waddell JP, Schemitsch EH (2010) Computer-assisted navigation for the assessment of fixed flexion in knee arthroplasty. Can J Surg 53(1):42–46PubMed

19.

Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85(6):830–835PubMed

20.

Lustig S, Fleury C, Goy D, Neyret P, Donell ST (2011) The accuracy of acquisition of an imageless computer-assisted system and its implication for knee arthroplasty. Knee 18(1):15–20PubMedCrossRef

21.

Doro LC, Hughes RE, Miller JD, Schultz KF, Hallstrom B, Urquhart AG (2008) The reproducibility of a kinematically-derived axis of the knee versus digitized anatomical landmarks using a knee navigation system. Open Biomed Eng J 2:52–56PubMedCrossRef

22.

Aderinto J, Brenkel IJ, Chan P (2005) Natural history of fixed flexion deformity following total knee replacement: a prospective five-year study. J Bone Joint Surg Br 87(7):934–936PubMedCrossRef

23.

Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y (2008) Knee flexion contracture will lead to mechanical overload in both limbs: a simulation study using gait analysis. Knee 15(6):467–472PubMedCrossRef

24.

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

25.

Ostrosky KM, VanSwearingen JM, Burdett RG, Gee Z (1994) A comparison of gait characteristics in young and old subjects. Phys Ther 74(7):637–644, discussion 644–636PubMed

26.

Jung MC, Park D, Lee SJ, Lee KS, Kim DM, Kong YK (2010) The effects of knee angles on subjective discomfort ratings, heart rates, and muscle fatigue of lower extremities in static-sustaining tasks. Appl Ergon 42(1):184–192PubMedCrossRef

27.

Kawahara S, Matsuda S, Fukagawa S, Mitsuyasu H, Nakahara H, Higaki H, Shimoto T, Iwamoto Y (2012) Upsizing the femoral component increases patellofemoral contact force in total knee replacement. J Bone Joint Surg Br 94(1):56–61PubMedCrossRef

28.

Mahoney OM, Kinsey T (2010) Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am 92(5):1115–1121PubMedCrossRef

29.

Emerson RH Jr, Martinez J (2008) Men versus women: does size matter in total knee arthroplasty? Clin Orthop Relat Res 466(11):2706–2710PubMedCrossRef

30.

Seil R, Pape D (2011) Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(9):1418–1432PubMedCrossRef

31.

Smith CK, Chen JA, Howell SM, Hull ML (2010) An in vivo study of the effect of distal femoral resection on passive knee extension. J Arthroplasty 25(7):1137–1142PubMedCrossRef

32.

Lu H, Mow CS, Lin J (1999) Total knee arthroplasty in the presence of severe flexion contracture: a report of 37 cases. J Arthroplasty 14(7):775–780PubMedCrossRef

33.

Asano H, Muneta T, Sekiya I (2008) Soft tissue tension in extension in total knee arthroplasty affects postoperative knee extension and stability. Knee Surg Sports Traumatol Arthrosc 16(11):999–1003PubMedCrossRef

Title: Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up
Authors: Sebastien Lustig
Corey J. Scholes
Tim J. Stegeman
Sam Oussedik
Myles R. J. Coolican
David A. Parker
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 9/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-012-1580-z

2024 ASCO Annual Meeting

Springer Medicine

Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up

Abstract

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2012

Behaviour of human physeal chondro-progenitorcells in early growth plate injury response in vitro

Bone mineral density changes of the proximal tibia after revision total knee arthroplasty. A randomised study with the use of porous tantalum metaphyseal cones

Reply to comment on Wang et al.: operative versus nonoperative treatment for acute Achilles tendon rupture

Establishing the radiation risk from fluoroscopic-assisted arthroscopic surgery of the hip

Balloon osteoplasty—a new technique for reduction and stabilisation of impression fractures in the tibial plateau: A cadaver study and first clinical application

Long-term stress distribution patterns of the ankle joint in varus knee alignment assessed by computed tomography osteoabsorptiometry