Knee Flexion after Total Knee Arthroplasty

Purpose. To identify factors related to knee flexion after total knee arthroplasty in a Chinese population. Methods. Records of 242 total knee arthroplasties were retrospectively reviewed. The parameters evaluated were age, gender, diagnosis, preoperative knee flexion and extension, preoperative flexion arc, tibiofemoral angle, Knee Society knee score and functional score, and implant design. Results. Advanced age, female gender, and good preoperative flexion and flexion arc were related to better postoperative flexion. Postoperative flexion tended to migrate to the middle range despite different ranges of preoperative flexion. Preoperative tibiofemoral malalignment had no significant effect on postoperative flexion. Conclusion. Contemporary designs of posterior stabilised prostheses with right and left femoral components were superior to older designs.

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Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1709675 ◽

2020 ◽

Author(s):

Jung-Won Lim ◽

Yong-Beom Park ◽

Dong-Hoon Lee ◽

Han-Jun Lee

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Functional Score ◽

Manipulation Under Anesthesia ◽

Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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Changes in Tibiofemoral Joint Space Following Total Knee Arthroplasty During Weight-Bearing Knee Motion

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206138 ◽

2009 ◽

Author(s):

Kartik M. Varadarajan ◽

Angela L. Moynihan ◽

Jong Keun Seon ◽

Andrew A. Freiberg ◽

Harry E. Rubash ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Weight Bearing ◽

Surgical Techniques ◽

Joint Space ◽

Extensor Mechanism ◽

Implant Design ◽

Tibiofemoral Joint ◽

Total Knee

Increasing the range of knee flexion following total knee arthroplasty (TKA) remains an important objective for design of new implants and advancement of surgical techniques. With the excellent long term (10–15 year) outcome of TKA, surgeons are more confident about performing the procedure on younger, more active patients demanding increased range of knee flexion [1–3]. Numerous factors have been linked to limited flexion (<120°) following TKA, including patient factors such as preoperative range of motion, intraoperative factors such as component malposition, and implant design [1–3]. Extensor mechanism overstretching due to overstuffing of the knee joint is hypothesized to be a contributing factor limiting knee flexion [1–4]. However, no study to date has investigated the changes in tibiofemoral joint space following TKA. The aim of this study was to examine pre- and post-operative tibiofemoral joint space in a group of TKA patients during weight-bearing knee flexion and to compare it to that in the normal/healthy knee. This could help determine if changes in the proximal-distal distance between the femur and the tibia (tibiofemoral joint space) could lead to extensor mechanism overstretching and consequently limited range of flexion.

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Improving Pre-Operative Flexion in Primary TKA: A Surgical Technique Emphasizing Knee Flexion with 5-Year Follow-Up

Reconstructive Review ◽

10.15438/rr.v4i2.71 ◽

2014 ◽

Vol 4 (2) ◽

pp. 29-36

Author(s):

Edward McPherson, MD FACS ◽

Denise Portugal, MD ◽

Matthew Dipane, BA ◽

Sherif Sherif, MD

Keyword(s):

Total Knee Arthroplasty ◽

Surgical Technique ◽

Femoral Component ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Primary Total Knee Arthroplasty ◽

Implant Design ◽

Consecutive Series ◽

High Flexion ◽

Total Knee

This study prospectively reviews a consecutive series of 228 primary total knee arthroplasty (TKA) procedures utilizing a technique to optimize knee flexion. The main features include: (1)the use of a “patellar friendly” femoral component and reduced thickness patellar components, (2) patient individualized adjustment of the femoral component rotation set strictly to the anterior-posterior femoral axis, (3)a rigorous flexion compartment debridement to remove non-essential posterior femoral bone with a Z-osteotome, and (4)incorporation of a rapid recovery protocol with features to promote knee flexion.Results were categorized into three groups: low pre-op flexion (90 degrees and below), regular pre-op flexion (91-125 degrees), and high pre-op flexion (126 degrees and above). Average flexion in the low flexion group improved by 20 degrees at 6 weeks, 28 degrees at 3 months, 31 degrees at 1 year, and 30 degrees at 5 years. In the regular flexion group, average flexion improved by 2 degrees at 6 weeks, 10 degrees at 3 months, 12 degrees at 1 year, and 13 degrees at 5 years. Finally, in the high flexion group, average flexion decreased by 7 degrees at 6 weeks, regained preoperative levels at 3 months, and increased by 3 degrees at 1 year and 4 degrees at 5 years.In summary, a technique that emphasizes patellofemoral kinematics can consistently improve flexion in TKA in short and long-term follow-up.Keywords: Total knee arthroplasty, range of motion, high flexion, surgical technique, implant design, AP AxisLevel of Evidence: AAOS Therapeutic Study Level III

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The role of the femoral anterior offset index on the degree of flexion in total knee arthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191780 ◽

2019 ◽

Vol 5 (3) ◽

pp. 376 ◽

Cited By ~ 1

Author(s):

João Maia Rosa ◽

Marcio Oliveira ◽

João Vide ◽

Maria Miguel Carvalho ◽

António Rodrigo Duarte ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Negative Effect ◽

Postoperative Flexion ◽

Total Knee ◽

Femoral Condyles

Background: Anterior projection of the femoral condyles is often disregarded as an issue in knee arthroplasty. Overstuffing the patellofemoral joint may limit knee flexion and be a source of patellofemoral complications, thus having an impact in satisfaction rates after total knee arthroplasty (TKA). Our hypothesis is that excessive anterior projection of the femoral condyles as a negative effect in flexion range after TKA, introducing a new concept, the anterior offset index (AOI).Methods: From a group of 99 consecutive patients who underwent TKA using patient specific instrumentation (PSI), we selected the patients with good pre-operative flexion range (above 90º) and a 6-minute walk test (6 MWT) ≥ 0 meters, evaluating the correlation between the AOI and the flexion range. A total of 23 patients were included in the study.Results: A moderate and positive correlation (r=0.488; p=0.018) between AOI and flexion range was found.Conclusions: Our results seem to indicate that the AOI influences postoperative flexion in TKA, in patients with a good pre-operative flexion and good functional outcome. AOI is an important concept to retain when optimizing knee flexion and minimizing patellofemoral complications. However, more studies need to be done in order to clarify the role of all the factors influencing post op flexion after TKA.

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Range of Motion Comparison Following Total Knee Arthroplasty with and without Patella Resurfacing

Reconstructive Review ◽

10.15438/rr.11.1.286 ◽

2021 ◽

Vol 11 ◽

Author(s):

Melissa Jackels ◽

Samantha Andrews ◽

Maya Matsumoto ◽

Kristin Mathews ◽

Cass Nakasone

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Knee Extension ◽

Implant Design ◽

Tourniquet Time ◽

Full Extension ◽

Total Knee ◽

Low Incidence

Background: Despite significant evaluation, no consensus has been reach for best clinical practice for resurfacing the patella during total knee arthroplasty. Further complicating the ability to reach a conclusion is the inclusion of several different implant types used in previous research. Questions/Purpose: The purpose of this study was to compare post-TKA outcomes between two cruciate retaining implants with or without patella resurfacing. Methods: This retrospective review included 289 patients (380 knees) with a minimum six-month follow-up. All patients received a CR implant, with either a symmetric or an asymmetric tibial baseplate. Post-TKA knee flexion was categorized as <120° and ≥120° and knee extension classified as 0° or >0° and required knee manipulations were noted. Descriptive, nonparametric statistics were performed and a multivariate logistic regression was performed to determine risk of poor range of motion and manipulations. Results: Age was significantly lower in the resurfaced group (p=0.001) and the resurfaced group had longer tourniquet time (p=0.003). The symmetric-resurfaced group had ≥120° of flexion and full extension in 72% and 98.7% of patients, respectively. Compared to symmetric-resurfaced, all other groups had a significantly greater risk of not reaching 120° of knee flexion (p<0.05). There were no significant differences in the risk of requiring a MUA between groups (p>0.06). Conclusions: The effect of resurfacing the patella on post-TKA outcomes may be influenced by tibial implant design. Compared to all other combinations, a symmetric tibial baseplate and resurfaced patella resulted in the highest percentage of patients reaching ≥120°, with a low incidence of manipulations.

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