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Sim CHS, Woo BJ, Liow MHL, Pang HN, Yeo SJ, Tay D, Liu X, Lim JBT, Chen JDY. Postponement of total knee arthroplasties due to pandemic causes significant deterioration on patients' preoperative knee and quality of life scores. J Orthop 2024; 55:114-117. [PMID: 38681830 PMCID: PMC11046234 DOI: 10.1016/j.jor.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Elective surgeries were postponed during the COVID-19 pandemic to alleviate healthcare strains, affecting majority of elective orthopaedic surgeries such as total knee arthroplasties (TKAs). The aim of this study is to evaluate the impact on knee function and quality of life of patients who had their planned TKA postponed due to the pandemic. Methods This is a retrospective analysis of data collected in a tertiary hospital. Patients included were diagnosed with primary knee osteoarthritis and they were initially scheduled for primary TKA between January to April 2020 but surgery was postponed by at least 6 months from the initial operative date. 160 patients were included in this study (53 males and 107 females, mean age 68.0 ± 8.1). Patients were assessed prior to initial surgery date and assessed again, prior to the postponed surgery date. Clinical scores included Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee scores (OKS) and Short-Form 36 Physical and Mental Component Scores. (SF36 PCS and MCS). Paired T-test was performed for parametric data whereas Wilcoxon signed-rank analysis was performed for non-parametric data. Results Comparing initial preoperative versus postponement preoperative scores, the cohort had significantly poorer KSKS (38.4 ± 15.4 and 36.5 ± 15.4, p = 0.034), SF36 PCS (34.3 ± 9.2 and 32.7 ± 8.6, p = 0.02) and OKS (34.9 ± 0.77 and 35.8 ± 8.6, p = 0.02) scores respectively. Conclusion The postponement of elective TKAs has resulted in a significant deterioration of knee scores and physical quality of live scores of patients in a short span of 6 months. Further studies can evaluate if there are repercussions on long term TKAs outcomes. Level of evidence Retrospective study, Level III.
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Affiliation(s)
- Craigven Hao Sheng Sim
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Bo Jun Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Darren Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Xuan Liu
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Jason Beng Teck Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
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No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3138-3154. [PMID: 35861866 PMCID: PMC9418337 DOI: 10.1007/s00167-022-07065-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA. METHODS This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered. RESULTS Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis. CONCLUSION There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA. LEVEL OF EVIDENCE Level I.
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The High Flex Total Knee Arthroplasty-Higher Incidence of Aseptic Loosening and No Benefit in Comparison to Conventional Total Knee Arthroplasty: Minimum 16-Years Follow-Up Results. Indian J Orthop 2020; 55:76-80. [PMID: 34122758 PMCID: PMC8149562 DOI: 10.1007/s43465-020-00276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE This prospective randomized study compares the clinical and radiographic long-term results at least 16 years after total knee arthroplasty (TKA) between a mobile-bearing high flex and a fixed-bearing posterior-stabilized knee. METHODS In 2000, we included 60 patients who underwent a TKA. Patients were divided into two groups. At the time of the follow-up after a minimum of 16 years (16.5 years ± 0.6), 16 patients had died for causes unrelated to the operation, 15 were lost to the follow-up. Five patients of the high flex group had a revision. The final evaluation included the hospital for special surgery score (HSS) and radiographs. Using the X-rays and the Knee Society Roentgenographic Evaluation and Scoring System, radiolucent lines and the maximal knee flexion were determined. RESULTS No significant differences between the two groups were found. The mean HSS score of LPS group patients was 87.9 (± 10.6) points and that of the high flex group was 93.1 (± 7.4) points. Five patients of the high flex group had undergone a reoperation. One knee was revised for painful mid-flexion instability and the others for symptomatic aseptic loosening of the components. CONCLUSION The long-term follow-up does not show any clear benefits and even a higher incidence of implant loosening using the mobile-bearing high-flex knee.
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Kim YH, Park JW, Kim JS. Comparison of High-Flexion Fixed-Bearing and High-Flexion Mobile-Bearing Total Knee Arthroplasties-A Prospective Randomized Study. J Arthroplasty 2018; 33:130-135. [PMID: 28844767 DOI: 10.1016/j.arth.2017.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is none, to our knowledge, about comparison of high-flexion fixed-bearing and high-flexion mobile-bearing total knee arthroplasties (TKAs) in the same patients. The purpose of this study was to determine whether clinical results; radiographic and computed tomographic scan results; and the survival rate of a high-flexion mobile-bearing TKA is better than that of a high-flexion fixed-bearing TKA. METHODS The present study consisted of 92 patients (184 knees) who underwent same-day bilateral TKA. Of those, 17 were men and 75 were women. The mean age at the time of index arthroplasty was 61.5 ± 8.3 years (range 52-65 years). The mean body mass index was 26.2 ± 3.3 kg/m2 (range 23-34 kg/m2). The mean follow-up was 11.2 years (range 10-12 years). RESULTS The Knee Society knee scores (93 vs 92 points; P = .531) and function scores (80 vs 80 points; P = 1.000), WOMAC scores (14 vs 15 points; P = .972), and UCLA activity scores (6 vs 6 points; P = 1.000) were not different between the 2 groups at 12 years follow-up. There were no differences in any radiographic and CT scan parameters between the 2 groups. Kaplan-Meier survivorship of the TKA component was 98% (95% confidence interval, 93-100) in the high-flexion fixed-bearing TKA group and 99% (95% confidence interval, 94-100) in the high-flexion mobile-bearing TKA group 12 years after the operation. CONCLUSION We found no benefit to mobile-bearing TKA in terms of pain, function, radiographic and CT scan results, and survivorship. Longer-term follow-up is necessary to prove the benefit of the high-flexion mobile-bearing TKA over the high-flexion fixed-bearing TKA.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Centers, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Centers, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Centers, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
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Springorum HR, Maderbacher G, Craiovan B, Lüring C, Baier C, Grifka J, Keshmiri A. No difference between standard and high flexion cruciate retaining total knee arthroplasty: a prospective randomised controlled study. Knee Surg Sports Traumatol Arthrosc 2015; 23:1591-7. [PMID: 24888221 DOI: 10.1007/s00167-014-3082-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/11/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this prospective, randomised, double-blind study was to test the hypotheses that patients with high-flexion total knee arthroplasty (TKA) have (1) a wider/greater range of motion (ROM) post-operatively and (2) higher levels of knee society score (KSS) and WOMAC score post-operatively compared to standard TKA. METHODS In this study, 28 high flexion with 31 standard TKAs were compared. We measured ROM, pre-operatively, on day 3, 7, 28, and after 6 and 36 months post-operatively as well as KSS and WOMAC score pre-operatively, on day 28 and after 6 and 36 months post-operatively. RESULTS No statistically significant differences were found between both groups with regard to the target parameters. The mean ROM was 113° (range 80°-140°, SD 13.4°) in the control group (standard TKA) and 117° (range 90°-140°, SD 12.3) in the study group (high-flexion TKA) at 36 months follow-up [p = not significant (n.s.)]. The KSS pre-operatively was 38.2 (range 8-64, SD 15.8) in the control group and 45.9 (range 8-74, SD 16.0) in the study group (n.s.) increasing to 157.6 in the control group and 156.7 in the study group (p = n.s) at 36 months follow-up. CONCLUSION This study could not confirm significant benefits of high-flexion TKA compared to standard TKA with regard to ROM and higher levels of KSS and WOMAC score. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Hans Robert Springorum
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany
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Jain S, Pathak AC, Kanniyan K, Kulkarni S, Tawar S, Mane P. High-flexion posterior-stabilized total knee prosthesis: is it worth the hype? Knee Surg Relat Res 2013; 25:100-5. [PMID: 24032097 PMCID: PMC3767894 DOI: 10.5792/ksrr.2013.25.3.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/07/2013] [Accepted: 07/20/2013] [Indexed: 11/07/2022] Open
Abstract
High-flexion knee prosthesis was introduced with the aim of obtaining higher degree of flexion and good survivorship in patients with high functional demands or those requiring squatting, kneeling, etc., which is more common in Asians. Based on all the research and experience with this prosthesis, it was concluded that high flexion designs meet the need of deeper degrees of flexion in selected sets of patients only. Results were equal and comparable to the traditional standard posterior-stabilized total knee arthroplasty design and superior to it in terms of gaining more flexion and fulfilling activities, such as squatting, kneeling, and sitting cross-legged.
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Affiliation(s)
- Sanjeev Jain
- Department of Orthopaedics, Dr LH Hiranandani Hospital, Mumbai, India
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Dennis DA, Heekin RD, Clark CR, Murphy JA, O'Dell TL, Dwyer KA. Effect of implant design on knee flexion. J Arthroplasty 2013; 28:429-38. [PMID: 23219622 DOI: 10.1016/j.arth.2012.07.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 06/26/2012] [Accepted: 07/02/2012] [Indexed: 02/01/2023] Open
Abstract
From March 2006 to August 2008, 93 subjects (186 knees) underwent simultaneous bilateral total knee arthroplasty performed by eight surgeons at North American centers. This randomized study was conducted to determine whether non-weight-bearing passive flexion was superior for knees receiving a posterior stabilized high flexion device compared to a posterior stabilized standard device in the contra-lateral knee. Weight-bearing single leg active flexion was one secondary endpoint. Follow-up compliance was 92.5%. Results show small, but significant superiority in the motion metrics for the high flexion device compared to the standard device 12 months after surgery, especially for a subgroup of patients with pre-operative flexion less than 120° in both knees. Thus, the ideal candidate for the high flexion device may be one with lesser pre-operative flexion.
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Jawed A, Kumar V, Malhotra R, Yadav CS, Bhan S. A comparative analysis between fixed bearing total knee arthroplasty (PFC Sigma) and rotating platform total knee arthroplasty (PFC-RP) with minimum 3-year follow-up. Arch Orthop Trauma Surg 2012; 132:875-81. [PMID: 22526193 DOI: 10.1007/s00402-012-1482-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since the introduction of mobile bearing total knee designs nearly 30 years back, many studies have been done to evaluate its long-term result. Comparison with fixed bearing designs has been done in the past, but the studies were confounded by variables such as disease, surgeon, bone quality, pain tolerance, etc. We attempt to eliminate these variables in this study. METHODS A total of 50 patients who had bilateral arthritis of the knee with similar deformity and pre-operative range of motion on both sides agreed to have one knee replaced with mobile bearing total knee design (PFC-RP) and the other with a fixed bearing design (PFC Sigma) were prospectively evaluated. Comparative analysis of both the designs was done at a mean follow-up of 40 months, minimizing patient, surgeon and observer related bias. Clinical and radiographic outcome, survival and complication rates were compared. RESULTS At a mean follow-up of 40 months (range 36-47 months), no benefit of mobile bearing (PFC-RP) over fixed bearing design (PFC Sigma) could be demonstrated with respect to Knee Society scores, pain scores, range of flexion, subject preference or patello-femoral complication rates. Radiographs showed no difference in prosthetic alignment. No patient required a revision surgery till last follow-up. CONCLUSIONS Our study demonstrated no advantage of the mobile-bearing arthroplasty over fixed bearing arthroplasty with regard to clinical results at short-term follow-up. However, longer follow-up is necessary to confirm whether these results are sustained.
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Affiliation(s)
- Akram Jawed
- Department of Orthopaedics, All India Institute of Medical Sciences, Room No. 5019, New Delhi 110029, India.
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Ball ST, Sanchez HB, Mahoney OM, Schmalzried TP. Fixed versus rotating platform total knee arthroplasty: a prospective, randomized, single-blind study. J Arthroplasty 2011; 26:531-6. [PMID: 20932706 DOI: 10.1016/j.arth.2010.06.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 06/09/2010] [Indexed: 02/01/2023] Open
Abstract
The purpose of this randomized, single-blind clinical trial was to compare a rotating platform (RP) total knee arthroplasty to a fixed-bearing (FB) total knee arthroplasty. Ninety-five knees in 69 patients were implanted by 2 surgeons. There were no significant differences in the preoperative demographics. At a minimum of 2-year follow-up, clinical outcomes and complication rates were similar, with the exception that the RP group had significantly better stair-climbing scores (P = .04). Postoperative range of motion was equally good in both groups (FB knees, 1°-125°; RP knees, 1-126°). There were no bearing dislocations in the RP group. In conclusion, this RP design performs at least as well as the FB version, and the RP patients reported better stair-climbing ability. Enthusiasm for this finding should be tempered by the relatively small sample size.
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Affiliation(s)
- Scott T Ball
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California 92103-8894, USA
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Lampe F, Sufi-Siavach A, Bohlen KE, Hille E, Dries SPM. One year after navigated total knee replacement, no clinically relevant difference found between fixed bearing and mobile bearing knee replacement in a double-blind randomized controlled trial. Open Orthop J 2011; 5:201-8. [PMID: 21687563 PMCID: PMC3115600 DOI: 10.2174/1874325001105010201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/01/2011] [Accepted: 04/11/2011] [Indexed: 01/14/2023] Open
Abstract
Background: The mobile bearing designs have not yet been shown to improve clinical outcome of total knee arthroplasty (TKA). In this prospective randomized study, we compared the short-term clinical results of a mobile bearing implant with those of the fixed bearing version of the same implant. Methods: We randomized 100 knees into two double-blind groups who received either the fixed (FB, 52 knees) or the mobile bearing (MB, 48 knees) version of the same implant. We used navigation to standardize the surgical technique. For up to one year, we recorded the Knee Society (KSS) and Oxford (OXF) scores. We performed an exploratory analysis of variance (ANOVA) to determine the influence of baseline scores as covariate and the extent of improvement in clinical outcome over time. Results: After one year, we did not detect any statistically significant difference between the two groups. The KSS scores differed by 2 points, the OXF scores by 1.1 points. Conclusion: Even with identical geometry of implant surfaces and a navigated surgical technique, first-year results do not support a preference for either a fixed or a mobile design.
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Affiliation(s)
- Frank Lampe
- Schön Klinik Hamburg-Eilbek, Dehnhaide 120, DE 22081 Hamburg, Germany
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Rahman WA, Garbuz DS, Masri BA. Randomized controlled trial of radiographic and patient-assessed outcomes following fixed versus rotating platform total knee arthroplasty. J Arthroplasty 2010; 25:1201-8. [PMID: 20022460 DOI: 10.1016/j.arth.2009.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 10/11/2009] [Indexed: 02/01/2023] Open
Abstract
This prospectively blinded randomized controlled study evaluated the difference in the functional and radiological outcomes in patients who received a press-fit condylar Sigma cemented cruciate-substituting total knee arthroplasty with either a rotating platform (RP) or a fixed bearing (FB). There were 51 joints in 49 patients: 24 joints in the RP group (mean follow-up, 43 months) and 27 joints in the FB group (mean follow-up, 40 months). At baseline, there was no significant difference in age, body mass index, preoperative diagnosis, Charnley class, range of motion, clinical and functional scores, between the RP and FB groups. At mid-term follow up both the RP and FB give equivalent results, but patients with the RP tended to have a higher activity level score.
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Affiliation(s)
- Wael A Rahman
- Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Mehin R, Burnett RS, Brasher PMA. Does the new generation of high-flex knee prostheses improve the post-operative range of movement?: a meta-analysis. ACTA ACUST UNITED AC 2010; 92:1429-34. [PMID: 20884983 DOI: 10.1302/0301-620x.92b10.23199] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A new generation of knee prostheses has been introduced with the intention of improving post-operative knee flexion. In order to evaluate whether this goal has been achieved we performed a systematic review and meta-analysis. Systematic literature searches were conducted on MEDLINE and EMBASE from their inception to December 2007, and proceedings of scientific meetings were also searched. Only randomised, clinical trials were included in the meta-analysis. The mean difference in the maximum post-operative flexion between the 'high-flex' and conventional types of prosthesis was defined as the primary outcome measure. A total of five relevant articles was identified. Analysis of these trials suggested that no clinically relevant or statistically significant improvement was obtained in flexion with the 'high-flex' prostheses. The weighted mean difference was 2.1° (95% confidence interval -0.2 to +4.3; p = 0.07).
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Affiliation(s)
- R Mehin
- Abbotsford Regional Hospital and Cancer Centre, 2080 McCallum Road, Abbotsford, British Columbia, Canada.
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Abstract
UNLABELLED The range of motion after TKA depends on many patient, surgical technique, and implant factors. Recently, high-flexion designs have been introduced as a means of ensuring or gaining flexion after TKA. We therefore evaluated factors affecting postoperative flexion to determine whether implant design influences longterm flexion. We prospectively collected data on patients receiving a primary Genesis II total knee replacement with a minimum of 1-year followup (mean, 5.4 years; range, 1-13 years). We recorded pre- and postoperative outcome measures, patient demographics, and implant design (cruciate retaining [CR, n = 160], posterior stabilized [PS, n = 1177], high-flex posterior stabilized [HF-PS, n = 197]). Backward stepwise linear regression modeling identified the following factors affecting postoperative flexion: preoperative flexion, gender, body mass index, and implant design. Independent of gender, body mass index, and preoperative flexion, patients who received a HF-PS and PS design implant had a mean of 8 degrees and 5 degrees more flexion, respectively, than those who received a CR implant. Patients with low flexion preoperatively (<100 degrees) were more likely to gain flexion, whereas those with high flexion preoperatively (>120 degrees) were most likely to maintain or lose flexion postoperatively. Controlling for implant design, patients with high flexion preoperatively (>120 degrees) were more likely to gain flexion with the HF-PS design implant (HF-PS = 32.0%; PS = 15.1%; CR = 4.5%). LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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McCalden RW, MacDonald SJ, Bourne RB, Marr JT. A randomized controlled trial comparing "high-flex" vs "standard" posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty. J Arthroplasty 2009; 24:33-8. [PMID: 19447001 DOI: 10.1016/j.arth.2009.03.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 03/15/2009] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study is to compare the range of motion and clinical outcomes of a standard posterior-stabilized (PS) vs the high-flex (HF) polyethylene tibial insert of a posterior cruciate substituting total knee arthroplasty system. One hundred patients were entered into a prospective, blinded, randomized clinical trial in which 50 patients received a Genesis II PS insert and 50 patients received a Genesis II HF insert (Smith & Nephew, Memphis, TN). At an average follow-up of 2.7 years (range, 2.3-3.1 years), there were no differences in any outcome measures (Western Ontario and McMaster Universities osteoarthritis index, Short-Form 12, Knee Society clinical rating scores, anterior knee pain). There were no differences (P = .811) in average knee flexion at 2 years (standard, 123 degrees +/- 7 degrees; HF, 124 degrees +/- 7 degrees). In summary, this prospective blinded randomized clinical trial demonstrated no differences between a PS and HF polyethylene design. Long-term evaluation will be required to comment on differences in polyethylene wear and implant longevity.
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Liu F, Ohdera T, Miyamoto H, Wasielewski RC, Komistek RD, Mahfouz MR. In vivo kinematic determination of total knee arthroplasty from squatting to standing. Knee 2009; 16:116-20. [PMID: 19101148 DOI: 10.1016/j.knee.2008.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 10/16/2008] [Accepted: 10/26/2008] [Indexed: 02/02/2023]
Abstract
This study analyzed three dimensional (3D) in vivo kinematic data from the squatting to standing position for 18 Japanese subjects (18 knees) implanted with either Legacy((R)) Posterior Stabilized (LPS) Flex Fixed Bearing TKA or LPS Flex Mobile Bearing TKA. Under weight-bearing conditions, for all patients, the average roll-forward motions for the medial and lateral condyles were 4.0+/-3.6 mm and 6.3+/-3.4 mm, and the average external axial rotation was 3.1 degrees +/-4.1 degrees . For both groups, the weight-bearing range-of-motion (ROM) (110.7 degrees +/-12.7 degrees ) was less than pre (127.2+/-15.5 degrees ) and post (135.6+/-5.4 degrees ) operative non-weight bearing ROM. As hypothesized, the incidence, average and maximum lift off for the squatting to standing activity were much less than those of deep knee bend (DKB), and condylar motions and kinematics were opposite that of the DKB. There was little statistical difference of their kinematic patterns during this activity between the LPS fixed and mobile TKA implants.
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Affiliation(s)
- Fei Liu
- Midlands Orthopaedics, 1910 Blanding St, Columbia, SC 29201, USA.
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Kim YH, Yoon SH, Kim JS. Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis. Clin Orthop Relat Res 2009; 467:493-503. [PMID: 18465188 PMCID: PMC2628493 DOI: 10.1007/s11999-008-0221-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 03/03/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Although the design features of the Medial Pivot fixed-bearing prosthesis reportedly improve kinematics compared with TKAs using fixed-bearings, clinical improvements have not been reported. We asked whether the clinical and radiographic outcomes, ranges of motion of the knee, patient satisfaction, and complication rates would be better in knees with a Medial Pivot fixed-bearing prosthesis than in those with a PFC Sigma mobile-bearing prosthesis. We compared the results of 92 patients who had a Medial Pivot fixed-bearing prosthesis implanted in one knee and a PFC Sigma mobile-bearing prosthesis implanted in the other. There were 85 women and seven men with a mean age of 69.5 years (range, 55-81 years). The minimum followup was 2 years (mean, 2.6 years; range, 2-3 years). The patients were assessed clinically and radiographically using the rating systems of the Hospital for Special Surgery and the Knee Society at 3 months, 1 year, and annually thereafter. Contrary to expectations, we found worse early clinical outcomes, smaller ranges of knee motion, less patient satisfaction, and a higher complication rate for the Medial Pivot fixed-bearing prosthesis than for the PFC Sigma mobile-bearing prosthesis. LEVEL OF EVIDENCE Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Korea, Ewha Womens University DongDaeMun Hospital, 70, ChongRo 6-Ga, ChongRo-Gu, Seoul, 110-783, Korea.
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Kim YH, Yoon SH, Kim JS. The long-term results of simultaneous fixed-bearing and mobile-bearing total knee replacements performed in the same patient. ACTA ACUST UNITED AC 2007; 89:1317-23. [PMID: 17957070 DOI: 10.1302/0301-620x.89b10.19223] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We compared the results of 146 patients who received an anatomic modular knee fixed-bearing total knee replacement (TKR) in one knee and a low contact stress rotating platform mobile-bearing TKR in the other. There were 138 women and eight men with a mean age of 69.8 years (42 to 80). The mean follow-up was 13.2 years (11.0 to 14.5). The patients were assessed clinically and radiologically using the rating systems of the Hospital for Special Surgery and the Knee Society at three months, six months, one year, and annually thereafter. The assessment scores of both rating systems pre-operatively and at the final review did not show any statistically significant differences between the two designs of implant. In the anatomic modular knee group, one knee was revised because of aseptic loosening of the tibial component and one because of infection. In addition, three knees were revised because of wear of the polyethylene tibial bearing. In the low contact stress group, two knees were revised because of instability requiring exchange of the polyethylene insert and one because of infection. The radiological analysis found no statistical difference in the incidence of radiolucent lines at the final review (Student’s t-test, p = 0.08), most of which occurred at tibial zone 1. The Kaplan-Meier survivorship for aseptic loosening of the anatomic modular knee and the low contact stress implants at 14.5 years was 99% and 100%, respectively, with a 95% confidence interval of 94% to 100% for both designs. We found no evidence of the superiority of one design over the other at long-term follow-up.
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Affiliation(s)
- Y.-H. Kim
- The Joint Replacement Center of Korea, Ewha Womans University Dong Dae Mun Hospital, 70, ChongRo 6-Ga, ChongRo-Gu, Seoul, Korea
| | - S.-H. Yoon
- The Joint Replacement Center of Korea, Ewha Womans University Dong Dae Mun Hospital, 70, ChongRo 6-Ga, ChongRo-Gu, Seoul, Korea
| | - J.-S. Kim
- The Joint Replacement Center of Korea, Ewha Womans University Dong Dae Mun Hospital, 70, ChongRo 6-Ga, ChongRo-Gu, Seoul, Korea
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Kim YH, Kim DY, Kim JS. Simultaneous mobile- and fixed-bearing total knee replacement in the same patients. ACTA ACUST UNITED AC 2007; 89:904-10. [PMID: 17673583 DOI: 10.1302/0301-620x.89b7.18635] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted a randomised prospective study to evaluate the clinical and radiological results of a mobile- and fixed-bearing total knee replacement of similar design in 174 patients who had bilateral simultaneous knee replacement. The mean follow-up was for 5.6 years (5.2 to 6.1). The total knee score, pain score, functional score and range of movement were not statistically different (p > 0.05) between the two groups. Osteolysis was not seen in any knee in either group. Two knees (1%) in the mobile-bearing group required revision because of infection; none in the fixed-bearing group needed revision. Excellent results can be achieved with both mobile- and fixed-bearing prostheses of similar design at mid-term follow-up. We could demonstrate no significant clinical advantage for a mobile bearing.
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Affiliation(s)
- Y-H Kim
- The Joint Replacement Center of Korea, Ewha Womans University, ChongRo 6-Ga, ChongRo-Gu, Seoul 110-783, Korea.
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