Abstract
Background
High flexion implants have been reported to provide better range of motion (ROM). The few studies analyzing the factors affecting the ROM are scarce. This study aims to find the factors that affect ROM when using a high flex knee design (INDUS knee).
Materials and Methods
Two hundred and fifty three consecutive patients of total knee arthroplasty (TKA) done by using INDUS knee prosthesis between Sept 2008 and Sept 2009 were included in the study. The cases with osteoarthritis (OA) and Rheumatoid arthritis (RA) were included in study. 5 patients were lost to followup and 248 patients (267 knees, 19 bilateral, 221 OA, and 46 RA) were analyzed for the following factors - sex, age, body mass index (BMI), preoperative ROM, flexion deformity, preoperative total knee score and functional score, time of tourniquet release and patella resurfacing. Subgroup classification using above factors was performed and statistical analysis of effect of all the above factors on final knee ROM was done. Assessment was done preoperatively and at 3 months, 6 months and 1 year postoperatively. The final outcome evaluation was done at one year followup.
Results
The mean age was 68.2 years (range 40-89 years) with 79 males and 189 females. The mean knee range improved from 97.62 ± 11° to 132 ± 8°. Factors that positively affect ROM of INDUS knee prosthesis at the end of 1 year were preoperative ROM, total knee score and functional score, and diagnosis of osteoarthritis, whereas BMI, preoperative flexion deformity has a negative influence on final flexion at the end of 1 year. Age and gender of the patients, patella resurfacing, and use of two different tourniquet protocols did not affect the final outcome.
Conclusion
Preoperative ROM and preoperative functional status are the most important factors affecting final range. Patients should be counseled accordingly and made to understand these factors.
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References
Kettelkamp DB, Johnson RJ, Smidt GL, Chao EY, Walker M. An electrogoniometric study of knee motion in normal gait. J Bone Joint Surg Am 1970;52:775–90.
Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther 1972;52:34–43.
Gatha NM, Clarke HD, Fuchs R, Scuderi GR, Insall JN. Factors affecting postoperative range of motion after total knee arthroplasty. J Knee Surg 2004;17:196–202.
Kawamura H, Bourne RB. Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 2001;6:248–52.
Insall JN, Ranawat CS, Aglietti P, Shine J. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 1976;58:754–65.
Kotani A, Yonekura A, Bourne RB. Factors affecting range of motion after contemporary total knee arthroplasty. J Arthroplasty 2005;7:850–6.
Schurman DJ, Parker JN, Ornstein D. Total condylar knee replacement. J Bone Joint Surg 1985;67A: 100–6.
Hanusch B, Lou TN, Warriner G, Hui A, Gregg P. Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomised controlled trial. Int Orthop 2010;34:349–54.
Tew M, Forster IW, Wallace WA. Effect of total knee arthroplasty on maximal flexion. Clin Orthop Relat Res 1989;247:168–74.
Ishii Y, Matsuda Y, Sakata S, Onda N, Omori G. Primary total knee arthroplasty using the Genesis I total knee prosthesis: A 5- to 10-year followup study. Knee 2005;12:341–5.
Hirsch HS, Lotke PA, Morrison LD. The posterior cruciate ligament in total knee surgery. Save, sacrifice, or substitute? Clin Orthop Relat Res 1994;309:64–8.
Ranawat AS, Rossi R, Loreti I, Rasquinha VJ, Rodriguez JA, Ranawat CS. Comparison of the PFC Sigma fixed-bearing and rotating-platform total knee arthroplasty in the same patient: Short-term results. J Arthroplasty 2004;19:35–9.
Laskin RS. The effect of a high-flex implant on postoperative flexion after primary total knee arthroplasty. Orthopedics 2007;30 (8 Suppl):86–8.
Ritter MA. High-flexion knee designs: More hype than hope? In the affirmative. J Arthroplasty 2006;21 (4 Suppl 1):40–1.
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.
Hamilton WG, Sritulanondha S, Engh CA Jr. Results of prospective, randomized clinical trials comparing standard and high-flexion posterior-stabilized TKA: A focused review. Orthopedics 2011;34:e500–3.
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;26:847–54.
Mehin R, Burnett RS, Brasher PM. Does the new generation of high-flex knee prostheses improve the postoperative range of movement?: A meta-analysis. J Bone Joint Surg Br 2010;92:1429–34.
Kelly MA. High-flexion knee designs: More hype than hope? In opposition. J Arthroplasty 2006;21:42–3.
Lee BS, Kim JM, Lee SJ, Jung KH, Lee DH, Cha EJ, et al. High-flexion total knee arthroplasty improves flexion of stiff knees. Knee Surg Sports Traumatol Arthrosc 2011;19:936–42.
Sancheti KH, Laud NS, Bhende H, Reddy G, Pramod N, Mani JN. The INDUS knee prosthesis-prospective multicentric trial of a posteriorly stabilized high-flex design: 2 years followup. Indian J Orthop 2009;43:367–74.
Sancheti KH, Sancheti PK, Shyam AK, Patil S, Dhariwal Q, Joshi R. Clinical and functional outcome of INDUS knee prosthesis-A prospective single centre study. Med J Western India 2009;35–43.
Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Phys Ther 1987;67:192–5.
Insall J, Dorr L, Scott R, Scott W. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–4.
Ritter MA, Campbell ED. Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty 1987;2:95–7.
Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat Award: Functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res 2008;466:2597–604.
Anouchi YS, McShane M, Kelly F Jr, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthop Relat Res 1996;331:87–92.
Insall JN, Scott WN, Ranawat CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 1979;61:173–80.
Long WJ, Scuderi GR. High-flexion total knee arthroplasty. J Arthroplasty 2008;23:6–10.
Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA. Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br 1993;75:950–5.
Shoji H, Solomonow M, Yoshino S, D’Ambrosia R, Dabezies E. Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics 1990;13:643–9.
Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 2003;85-A: 1278–85.
Schurman DJ, Matityahu A, Goodman SB, Maloney W, Woolson S, Shi H, et al. Prediction of postoperative knee flexion in Insall-Burstein II total knee arthroplasty. Clin Orthop Relat Res 1998;353:175–84.
Farahini H, Moghtadaei M, Bagheri A, Akbarian E. Factors influencing range of motion after total knee arthroplasty. Iran Red Crescent Med J. 2012 Jul;14(7):417–21.
Ritter MA, Stringer EA. Predictive range of motion after total knee replacement. Clin Orthop Relat Res 1979;143:115–9.
Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T. Maximizing flexion after total knee arthroplasty: The need and the pitfalls. J Arthroplasty 2002;17 (4 Suppl 1):59–62.
Burnett RS, Boone JL, McCarthy KP, Rosenzweig S, Barrack RL. A prospective randomized clinical trial of patellar resurfacing and nonresurfacing in bilateral TKA. Clin Orthop Relat Res 2007;464:65–72.
Wakankar HM, Nicholl JE, Koka R, D’Arcy JC. The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 1999;81:30–3.
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;87:1470–75.
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;20:674–79.
Seon JK, Song EK, Lee JY. Comparison of range of motion of high-flexion prosthesis and mobile-bearing prosthesis in total knee arthroplasty. Orthopedics 2005;28(10 Suppl):s1247–s1250.
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Sancheti, K.H., Sancheti, P.K., Shyam, A.K. et al. Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: A prospective study. IJOO 47, 50–56 (2013). https://doi.org/10.4103/0019-5413.106901
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DOI: https://doi.org/10.4103/0019-5413.106901