A Randomized, Prospective Study of Primary Total Knee Components Designed for Increased Flexion

Weeden, Steven H.; Schmidt, Robert H.

doi:10.1016/j.arth.2006.04.007

Cited by 58 publications

(68 citation statements)

References 11 publications

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“…This is similar to previous reports that Western patients with more than 120°of preoperative flexion experienced a decrease in flexion range [30,46]. There is a tendency for better postoperative flexion after TKA performed in Asian countries [5, 7, 8, 17, 18, 20, 24-26, 34, 40, 41, 43, 45, 50] than after TKA performed in Western countries [1,35,39,47,49] (Table 3). The higher threshold in the present study (135°versus 120°) may be understood in the same context of higher postoperative flexion in an Asian population.…”

Section: Discussionsupporting

confidence: 89%

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Lee

Chung²,

Kim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses.Questions/purposes We therefore determined (1) the rate of achieving postoperative HF after HF TKA; (2) whether the aseptic loosening rate of HF prostheses is high; and (3) whether the survivorship was worsened in patients who achieved postoperative deep knee flexion in our cohort of Korean patients. Methods We retrospectively reviewed 488 patients who had 698 primary TKAs using the NexGen 1 Legacy Posterior-Stabilized Flex system implanted from 2003 to 2010. There were 40 men and 448 women with a mean age of 68 years. We obtained Hospital for Special Surgery scores, maximal flexion, and radiographs. The minimum followup for functional and radiographic evaluations was 2 years (median, 4.8 years; range, 2-8.7 years). We performed a survival analysis on all patients for aseptic loosening. Results Three hundred sixty knees (52%) could achieve C 135°maximum flexion. Six of the 698 knees (0.9%) developed aseptic loosening (three femoral and three tibial). The survival at 5 years for aseptic loosening was 99.1%. The overall survival for aseptic failure did not differ between knees that achieved HF and those that did not.

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Section: Discussionsupporting

confidence: 89%

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Lee

Chung²,

Kim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Three of the four prospective randomised trials that compared the use of a PS and an HF TKA design failed to show differences in ROM [14,20,29]. The remaining study by Weeden et al did report better flexion in the HF group compared with the PS group (133°and 120°, p<0.05) [37].…”

Section: Discussionmentioning

confidence: 97%

“…In a systematic literature review focusing on outcomes after HF TKA, Murphy et al found that there was insufficient evidence to support the view that these new TKA designs improved ROM or functional performance [24]. This review included nine studies [1, 8,10,14,17,27,29,34,37] with 399 HF TKAs in 370 patients. They conclude that the claims of greater flexion, ROM, and function for HF TKA reported in some of those studies were not supported due to poor study designs, short follow-up periods, inadequate blinding, and use of functional outcome measures that lacked sensitivity [24].…”

Section: Discussionmentioning

confidence: 99%

“…There has been a recent interest in the development and use of TKA designs capable of accommodating the kinematics of high flexion [2,10,26,35,37]. The design features that have been introduced in the high-flexion (HF) knee replacements include changes in the geometry of the polyethylene insert [2,18] with or without changes in the femoral component [10,35,37]. The design changes aim at facilitating flexion by improving the TKA kinematics in high flexion.…”

Section: Introductionmentioning

confidence: 99%

“…The design changes aim at facilitating flexion by improving the TKA kinematics in high flexion. It remains debatable whether the design changes in the so called HF TKA will not only facilitate but also increase postoperative flexion and diminish the manipulation rate [1, 8,10,14,17,18,22,27,29,37].…”

Section: Introductionmentioning

confidence: 99%

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Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

Malik

Salas²,

Ari

et al. 2009

International Orthopaedics (SICOT)

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It is debatable whether high-flexion (HF) total knee arthroplasty (TKA) designs will improve postoperative flexion and function or will diminish the need for manipulation under anaesthesia (MUA). We retrospectively analysed range of motion (ROM), flexion, Knee Society Score (KSS), and rate of MUA in a consecutive group of patients who underwent TKA with a conventional posterior stabilised (PS) insert or an HF insert using identical surgical technique, implant design, and postoperative care. Fifty TKAs with a standard PS insert were matched for patient's age, gender, preoperative ROM, and KSS with 50 TKA performed with an HF insert. The patient's ROM and KSS were evaluated at six weeks, four months, and one year postoperatively. The outcome variables (flexion, ROM, KSS, and manipulation rate) in both groups were compared using the generalised estimating equations method. A second analysis of patients with preoperative flexion ≥120°was performed. The ROM, flexion, and patient-reported KSS was similar in both groups at each time period. The rate of MUA was also similar. Patients with a preoperative ROM of at least 120°showed similar results. Our study found that one year after surgery, patients who underwent TKA with a PS or an HF insert achieved similar flexion, ROM, and function.

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High‐Flexion Implants vs. Conventional Design Implants

Paterson

Orec

Naudie

2011

Evidence‐Based Orthopedics

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A Randomized, Prospective Study of Primary Total Knee Components Designed for Increased Flexion

Cited by 58 publications

References 11 publications

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

High‐Flexion Implants vs. Conventional Design Implants

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