The extensor efficiency of unicompartmental, bicompartmental, and total knee arthroplasty

Aims Unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BCA) have been associated with improved functional outcomes compared to total knee arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function. Methods Extensor function was measured for 16 cadaveric knees and then retested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensor efficiency was calculated for ranges of knee flexion associated with common activities of daily living. Data were analyzed with repeated measures analysis of variance (α = 0.05). Results Compared to native, there were no reductions in either extension moment or efficiency following UKA. Conversion to BCA resulted in a small decrease in extension moment between 70° and 90° flexion (p < 0.05), but when examined in the context of daily activity ranges of flexion, extensor efficiency was largely unaffected. Following TKA, large decreases in extension moment were measured at low knee flexion angles (p < 0.05), resulting in 12% to 43% reductions in extensor efficiency for the daily activity ranges. Conclusion This cadaveric study found that TKA resulted in inferior extensor function compared to UKA and BCA. This may, in part, help explain the reported differences in function and satisfaction differences between partial and total knee arthroplasty. Cite this article: Bone Joint Res 2021;10(1):1–9.

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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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Post-operative blood loss in total knee arthroplasty: knee flexion versus pharmacological techniques

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-013-2674-x ◽

2013 ◽

Vol 22 (11) ◽

pp. 2756-2762 ◽

Cited By ~ 15

Author(s):

Pierluigi Antinolfi ◽

Bernardo Innocenti ◽

Auro Caraffa ◽

Giuseppe Peretti ◽

Giuliano Cerulli

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Operative Blood Loss ◽

Total Knee

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Modern femoral component design in total knee arthroplasty shows a lower patellar contact force during knee flexion compared with its predecessor

The Knee ◽

10.1016/j.knee.2021.03.007 ◽

2021 ◽

Vol 30 ◽

pp. 1-8

Author(s):

Naoki Nakano ◽

Yuichi Kuroda ◽

Toshihisa Maeda ◽

Koji Takayama ◽

Shingo Hashimoto ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Contact Force ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Component Design ◽

Total Knee

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Assessing the knee flexion range of motion after total knee arthroplasty: Technology versus senses

Journal of Bodywork and Movement Therapies ◽

10.1016/j.jbmt.2021.09.011 ◽

2021 ◽

Author(s):

Umut Ziya Kocak ◽

Ortac Guran ◽

Serpil Kalkan ◽

Erol Kaya ◽

Merve Kurt ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Total Knee

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Letter regarding “Does cruciate-retaining total knee arthroplasty enhance knee flexion in Western and East Asian patient populations? A meta-analysis”

The Knee ◽

10.1016/j.knee.2013.11.018 ◽

2014 ◽

Vol 21 (4) ◽

pp. 878

Author(s):

Xiaobo Xie ◽

Lijun Lin ◽

Qi Li

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Meta Analysis ◽

East Asian ◽

Asian Patient ◽

Cruciate Retaining ◽

Total Knee

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Biomechanical Effects of Kneeling With Posterior Cruciate Retaining and Posterior Cruciate Substituting Total Knee Arthroplasty

ASME 2009 4th Frontiers in Biomedical Devices ◽

10.1115/biomed2009-83069 ◽

2009 ◽

Author(s):

Jason K. Hofer ◽

Ryuichi Gejo ◽

Michelle H. McGarry ◽

Thay Q. Lee

Keyword(s):

Total Knee Arthroplasty ◽

Activities Of Daily Living ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Daily Living ◽

Middle Eastern ◽

Large Role ◽

Asian Countries ◽

Cruciate Retaining ◽

Total Knee

Kneeling is an activity that is important in certain occupations and recreational activities. Culturally, kneeling plays a large role in Middle Eastern and Asian countries, where activities of daily living require the ability to kneel and achieve deep knee flexion.

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Comparison of periarticular multidrug infiltration and epidural catheter use in total knee arthroplasty: A prospective randomized controlled study

Journal of Orthopaedic Surgery ◽

10.1177/2309499020910663 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949902091066

Author(s):

Taku Ukai ◽

Hamahashi Kosuke ◽

Goro Ebihara ◽

Masahiko Watanabe

Keyword(s):

Total Knee Arthroplasty ◽

Epidural Catheter ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Whole Body ◽

Controlled Study ◽

Randomized Controlled ◽

Catheter Group ◽

Significant Difference ◽

Total Knee

Purpose: The purpose of this study was to assess the effectiveness of periarticular multidrug infiltration (PMDI) and compare it with that of epidural catheter use. Methods: Fifty-eight patients (58 joints) who underwent total knee arthroplasty were included in this single-center, prospective, parallel, randomized, controlled trial. Preoperatively, patients were randomly categorized into the PMDI and epidural catheter groups. We evaluated postoperative pain (visual analog scale (VAS) and narcotic consumption), functional outcomes (range of motion (ROM) of knee flexion, the day patients could perform the straight-leg raising (SLR) test, and day of starting cane use), and laboratory data (white blood cell (WBC) and C-reactive protein (CRP)). Results: There was no significant difference in the VAS score, ROM of knee flexion, the day patients could do SLR, and the day of starting cane use between the PMDI and epidural catheter groups. However, the PMDI group could perform SLR on a postoperative day (POD) 1 ( p < 0.05). WBC level on POD 1 was significantly higher in the PMDI group ( p < 0.05), whereas the CRP levels on POD 1 ( p < 0.01), 3 ( p < 0.01), and 5 ( p < 0.01) were significantly lower in the PMDI group than in the epidural catheter group. The frequency of side effects was not significantly different between the groups. Conclusion: PMDI was as effective as epidural catheter use for pain control. A higher percentage of patients who underwent PMDI could perform SLR on POD 1; therefore, the functional recovery was earlier in the PMDI group than in the epidural catheter group. PMDI may suppress inflammation in the whole body because of steroids.

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