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Fary C, Cholewa J, Ren AN, Abshagen S, Anderson MB, Tripuraneni K. Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation. ARTHROPLASTY 2023; 5:62. [PMID: 38044446 PMCID: PMC10694935 DOI: 10.1186/s42836-023-00216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/27/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Range of motion (ROM) following total knee replacement (TKR) has been associated with patient satisfaction and knee function, and is also an early indicator of a successful procedure. Robotic-assisted TKR (raTKR) is considered to reproduce more precise resections, and, as a result, may be associated with improved early patient satisfaction compared to manual TKR (mTKR). The purpose of this study was to evaluate the early postoperative active ROM (aROM) between raTKR and mTKR. METHODS A total of 216 mTKR patients were propensity-matched, in terms of age, gender, comorbidities, and BMI, to 216 raTKR cases. Intraoperative and immediate postoperative adverse events were collected. Knee flexion and extension aROM were measured preoperatively and at one- and three months after operation. RESULTS Changes in flexion aROM were significantly greater in raTKR vs. mTKR at one- (6.9°, 95% CI: 3.5, 10.4°) and three months (4.9°, 95% CI: 2.1, 7.7°). Flexion aROM was greater at three postoperative months compared to preoperative aROM only in the raTKR group, and raTKR patients had higher odds of achieving ≥ 90° of flexion at one month after operation (OR: 2.15, 95% CI: 1.16, 3.99). There were no significant differences between groups in intraoperative (P > 0.999) or postoperative adverse events. CONCLUSIONS Compared with mTKR, raTKR resulted in less loss of aROM immediately after operation and a faster recovery of aROM within three months after operation. TRIAL REGISTRATION Clinicaltrials.gov (NCT# 03737149).
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Affiliation(s)
- Camdon Fary
- Epworth Foundation, Richmond, VIC, 3121, Australia
- Department of Orthopaedics, Western Hospital, Melbourne, 3011, Australia
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Kim SE, Ro DH, Lee MC, Cholewa JM. Early- to Mid-Term Review of a Prospective, Multi-Center, International, Outcomes Study of an Anatomically Designed Implant with Posterior-Stabilized Bearing in Total Knee Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2105. [PMID: 38138207 PMCID: PMC10744842 DOI: 10.3390/medicina59122105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: National joint registries report higher total knee arthroplasty (TKA) revision rates in posterior-stabilized (PS) systems compared to non-posterior-stabilized designs. The purpose of this study was to investigate the implant survivorship and clinical outcomes of an anatomic implant with a PS bearing. Materials and Methods: An early- to mid-term follow-up of a prospective, multi-center, non-controlled outcomes study of patients who received primary TKA between November 2014 and June 2017 was performed. A total of 800 cases using PS bearings that were implanted in 664 patients were monitored post-operatively for their implant survivorship and adverse events for up to five years. The Knee Society Knee and Function scores, patient satisfaction, the five-dimensional European Quality of Life questionnaire, and range of motion (ROM) were evaluated pre-operatively and post-operatively at six weeks, six months, one year, two years, three years, and five years. Results: The mean follow-up period was 3.7 ± 1.3 years, and the three-year implant survival rate was 99.3% (95% CI: 98.4%, 99.7%) with five revisions during the five-year follow-up. Patient satisfaction was 96.1% at six weeks and increased to 99.3% at one year. All patient-reported outcome measures significantly (p < 0.0001) increased up to the one-year follow-up and then remained stable up to the five-year follow-up. Conclusions: This study supports the excellent survivorship and patient-reported outcomes of the Persona® Knee system using cemented, fixed bearing, posterior-stabilized components with minimal complications at early- to mid-term follow-up in an international Asian population. Ongoing observations are being performed to investigate the mid- to long-term survivorship and clinical outcomes associated with this knee system.
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Affiliation(s)
- Sung Eun Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jon Gno-Gu, Seoul 03080, Republic of Korea; (S.E.K.); (M.C.L.)
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jon Gno-Gu, Seoul 03080, Republic of Korea; (S.E.K.); (M.C.L.)
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jon Gno-Gu, Seoul 03080, Republic of Korea; (S.E.K.); (M.C.L.)
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Yocum D, Elashoff B, Verta P, Armock G, Yergler J. Patient reported outcomes do not correlate to functional knee recovery and range of motion in total knee arthroplasty. J Orthop 2023; 43:36-40. [PMID: 37564705 PMCID: PMC10409997 DOI: 10.1016/j.jor.2023.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Background Many total knee arthroplasty (TKA) patients exhibit continued pain and limited function following surgery. Determining TKA outcomes is typically reliant on post-operative evaluations and completing patient-reported outcomes (PROMs). Due to low compliance rates, it is essential to identify new strategies for monitoring patients. The purpose of this analysis was to assess the correlations between gait kinematics, PROMs, and knee range of motion (ROM). Methods 130 patients (75 female) received Persona IQ TKA (Zimmer Biomet, Warsaw, IN, USA) which includes a stem extension with embedded accelerometer and gyroscope. PROM scores were compared at baseline and 6 weeks post-TKA using a paired t-test. Gait kinematics were recorded daily via the Persona IQ stem extension. Pearson's correlation coefficients were derived between PROMs and average gait kinematics. Results Knee Injury and Osteoarthritis Outcome Score (KOOS Jr.) and Veterans RAND 12 (VR-12) physical scores improved following surgery (p ≤ 0.001, p = 0.003, respectively). Weak statistically significant correlations were found between PROMS and gait kinematics. Conclusion Weak correlations between PROMs and gait kinematics indicate patient perception of improvement and objectively measured functional status may not be interchangeable. Further, compliance with Persona IQ data reached 95.4-97.7% (depending on the parameter) at 6 weeks following surgery, a 20% higher compliance rate over PROMs. Daily functional measurements provide insight into the patient's progression and may be useful in detecting poor outcomes.
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Affiliation(s)
- Derek Yocum
- South Bend Orthopaedics, 53880 Carmichael Dr., South Bend, IN, 46635, USA
| | | | - Patrick Verta
- Canary Medical, 2710 Loker Ave W, Carlsbad, CA, 92010, USA
| | - Gary Armock
- South Bend Orthopaedics, 53880 Carmichael Dr., South Bend, IN, 46635, USA
| | - Jeffrey Yergler
- South Bend Orthopaedics, 53880 Carmichael Dr., South Bend, IN, 46635, USA
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Batko BD, Ippolito JA, Gupta A, Bukowiec L, Potter JS, Joshi T, Kissin YD. Synergistic effects of robotic surgery and IPACK nerve block on reduction of opioid consumption in total knee arthroplasty. J Orthop 2022; 34:226-232. [PMID: 36120477 PMCID: PMC9474319 DOI: 10.1016/j.jor.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background There are numerous strategies to combat postoperative analgesia and expedite recovery after total knee arthroplasty (TKA). The purpose of this study was to determine opioid consumption, length of stay, and functional outcomes after robotic versus standard TKA in the setting of various regional pain modalities. Methods A consecutive series of patients treated with unilateral primary robotic or standard TKA from January 2018-February 2021 were retrospectively identified. Regional pain modalities included peri-articular injection (PAI), adductor canal block (ACB), and infiltration between popliteal artery and capsule of knee (IPACK). Patient demographics, operative/perioperative variables, and postoperative function were recorded. Daily opiate consumption was calculated as morphine milligram equivalents (MME). Multivariate regression was performed to control for age, sex, and race. Results After review, 283 patients (177 Females; 106 Males) were included. Robotic TKA patients received IPACK + ACB (36), while standard TKA patients received either ACB (45), IPACK + ACB (167), or PAI (35). Daily inpatient opioid consumption in the standard IPACK + ACB (p = 0.02) and robotic IPACK + ACB groups (p = 0.0001) was significantly lower compared to standard ACB. When combined with IPACK block, robotic procedures synergistically lowered opiate consumption (p = 0.004) compared to standard procedures and led to earlier discharge (p = 0.003). The robotic IPACK + ACB cohort also demonstrated improved early ambulation compared to standard ACB, (p = 0.05), whereas the same benefit was not seen for patients who received IPACK during standard TKA. Conclusions The utilization of IPACK block decreases inpatient postoperative opioid requirements following TKA. Robotic TKA and IPACK block appeared to have a synergistic effect on opioid consumption and postoperative recovery.
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Key Words
- ACB, adductor canal block
- ANOVA, analysis of variance
- ASA, American Society of Anesthesiologists
- BMI, body mass index
- CI, confidence interval
- FNB, femoral nerve block
- IPACK, infiltration between the popliteal artery and the capsule of the knee
- Infiltration between popliteal artery and capsule of knee (IPACK) block
- LOS, length of stay
- MME, morphine milligram equivalents
- NJPMP, New Jersey Prescription Monitoring Program
- Opioids
- PAI, periarticular injection
- ROM, range of motion
- Regional anesthesia
- Robotic surgery
- SD, standard deviation
- TKA, total knee arthroplasty
- Total knee arthroplasty (TKA)
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Affiliation(s)
- Brian D Batko
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ, 07103, USA
| | - Joseph A Ippolito
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ, 07103, USA
| | - Arjun Gupta
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ, 07103, USA
| | - Lainey Bukowiec
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, 340 Kingsland Street, Nutley, NJ, 07110, USA
| | - James S Potter
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ, 07103, USA
| | - Tej Joshi
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ, 07103, USA
| | - Yair D Kissin
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, 340 Kingsland Street, Nutley, NJ, 07110, USA
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Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ, Blyth MJG. Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial. Bone Joint J 2022; 104-B:433-443. [PMID: 35360949 DOI: 10.1302/0301-620x.104b4.bjj-2021-0837.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. METHODS A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model. RESULTS Both interventions were shown to be effective treatment options, with no significant differences shown between interventions for the primary outcome of this study (18/35 (51.4%) biphasic TKA patients vs 20/31 (64.5%) biphasic bi-UKA patients; p = 0.558). All outcomes were compared to an age-matched, healthy cohort that outperformed both groups, indicating residual deficits exists following surgery. Logistic regression analysis of primary outcome with secondary outcomes indicated that the most significant predictor of postoperative biphasic knee moments was preoperative knee moment profile and trochlear degradation (Outerbridge) (R2 = 0.381; p = 0.002, p = 0.046). A separate regression of alignment against primary outcome indicated significant bi-UKA femoral and tibial axial alignment (R2 = 0.352; p = 0.029), and TKA femoral sagittal alignment (R2 = 0.252; p = 0.016). The bi-UKA group showed a significant increased ability in the proprioceptive joint position test, but no difference was found in more dynamic testing of proprioception. CONCLUSION Robotic arm-assisted bi-UKA demonstrated equivalence to TKA in achieving a biphasic gait pattern after surgery for osteoarthritis of the knee. Both treatments are successful at improving gait, but both leave the patients with a functional limitation that is not present in healthy age-matched controls. Cite this article: Bone Joint J 2022;103-B(4):433-443.
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Affiliation(s)
- Matthew S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus D MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip J Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Mark J G Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Blyth MJG, Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ. Early outcomes after robotic arm-assisted bi-unicompartmental knee arthroplasty compared with total knee arthroplasty: a prospective, randomized controlled trial. Bone Joint J 2021; 103-B:1561-1570. [PMID: 34587803 PMCID: PMC9948427 DOI: 10.1302/0301-620x.103b10.bjj-2020-1919.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively. METHODS A per protocol analysis of 76 patients, 43 of whom underwent TKA and 34 of whom underwent bi-UKA, was performed from a prospective, single-centre, randomized controlled trial. Diaries kept by the patients recorded pain, function, and the use of analgesics daily throughout the first week and weekly between the second and sixth weeks. Patient-reported outcome measures (PROMs) were compared preoperatively, and at three months and one year postoperatively. Data were also compared longitudinally and a subgroup analysis was conducted, stratified by preoperative PROM status. RESULTS Both operations were shown to offer comparable outcomes, with no significant differences between the groups across all timepoints and outcome measures. Both groups also had similarly low rates of complications. Subgroup analysis for preoperative psychological state, activity levels, and BMI showed no difference in outcomes between the two groups. CONCLUSION Robotic arm-assisted, cruciate-sparing bi-UKA offered similar early clinical outcomes and rates of complications to a mechanically aligned TKA, both in the immediate postoperative period and up to one year following surgery. Further work is required to identify which patients with osteoarthritis of the knee will derive benefit from a cruciate-sparing bi-UKA. Cite this article: Bone Joint J 2021;103-B(10):1561-1570.
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Affiliation(s)
- Mark J. G. Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK,Correspondence should be sent to Mark J. G. Blyth. E-mail:
| | - Matthew S. Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G. Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus D. MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip J. Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Good Postoperative Flexion Angle Improves Knee Function and Improvement of Flexion Angle Increases Patient Satisfaction After Total Knee Arthroplasty. J Arthroplasty 2021; 36:3137-3140. [PMID: 34034923 DOI: 10.1016/j.arth.2021.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/05/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a well-established procedure for treating knee joint diseases. However, the postoperative range of motion (ROM) varies and is an important indicator of TKA success. Recently, patient-reported outcome measures (PROMs) and patient satisfaction have drawn attention. However, the relationship between ROM and knee function obtained by PROM and satisfaction is not well understood. METHODS We retrospectively reviewed the data of 375 patients who underwent 500 primary TKA procedures. We measured the ROM before and after surgery. Knee joint function was evaluated using the Knee Injury Osteoarthritis Outcome Score, a PROM, and patients were classified into good function and poor function groups. Patient satisfaction was evaluated on a 5-graded scale as overall satisfaction, and patients were divided into a satisfied or a dissatisfied group according to the obtained scores. ROM was compared between the 2 groups, then significantly different factors were analyzed using multiple logistic regression analysis. Moreover, cut-off points of ROM for obtaining good function and patient satisfaction were determined using ROC curve analysis. RESULTS The postoperative flexion angle had a significant effect on knee function (P < .001). The cut-off value of the postoperative flexion angle for good knee function was 120°. The improvement in flexion angle had a significant effect on patient satisfaction (P = .004). The cut-off value for the improvement in the flexion angle was 5°. CONCLUSION The postoperative flexion angle had a significant effect on knee function and improvement in the flexion angle had a significant effect on patient satisfaction.
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Han HS, Kim JS, Lee B, Won S, Lee MC. A high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population. BMC Musculoskelet Disord 2021; 22:565. [PMID: 34154538 PMCID: PMC8215776 DOI: 10.1186/s12891-021-04369-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/17/2021] [Indexed: 02/25/2023] Open
Abstract
Background This study investigated whether achieving a higher degree of knee flexion after TKA promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life. Methods Clinical data on 912 consecutive primary TKA cases involving a single high-flexion posterior stabilized fixed-bearing prosthesis were retrospectively analyzed. Demographic and clinical data were collected, including knee flexion angle, the ability to perform high-flexion activities, and patient satisfaction and quality of life. Results Of the cases, 619 (68%) achieved > 130° of knee flexion after TKA (high flexion group). Knee flexion angle and clinical scores showed significant annual changes, with the maximum improvement seen at 5 years and slight deterioration observed at 10 years postoperatively. In the high flexion group, more than 50% of the patients could not kneel or squat, and 35% could not stand up from on the floor. Multivariate analysis revealed that > 130° of knee flexion, the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient satisfaction after TKA, while the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient quality of life after TKA. Conclusions High knee flexion angle (> 130°) after TKA increased the ease of high-flexion activities and patient satisfaction. The ease of high-flexion activities also increased quality of life after TKA in our Asian patients, who frequently engage in these activities in daily life.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jong Seop Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Bora Lee
- Department of Statistics, Graduate School of Chung-Ang University, Seoul, South Korea
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Oka T, Wada O, Asai T, Maruno H, Mizuno K. Importance of knee flexion range of motion during the acute phase after total knee arthroplasty. Phys Ther Res 2021; 23:143-148. [PMID: 33489651 DOI: 10.1298/ptr.e9996] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We investigate the association with knee flexion range of motion (ROM) during the acute phases and that at 12 months after total knee arthroplasty (TKA). We also clarified the cut-off ROM during the acute phases in predicting the goal of knee flexion ROM at 12 months. METHODS In this retrospective study, 193 patients with knee osteoarthritis (female:144 patients, age:73.2 ± 7.7 years) who underwent unilateral TKA at an orthopedic clinic were recruited. They underwent assessments of knee flexion ROM at 5 days, 1 month, and 12 months after TKA. The goal of knee flexion ROM at 12 months after TKA was set at 120°. Single and logistic-regression analyses were performed with the dependent variables including the outcome of the goal of knee flexion ROM at 12 months, and the independent variables included knee flexion ROM at 5 days and 1 month, separately. We calculated the cut-off ROM at 5 days and 1 month for predicting the goal of knee flexion ROM at 12 months with receiver operating curve analysis. RESULTS Knee flexion ROM at 5 days and 1 month were significantly associated with the goal of that at 12 months (p < 0.01). The cut-off ROM were 85° at 5 days and 105° at 1 month separately. CONCLUSIONS Our results suggest the importance of early improvement in knee flexion ROM after TKA, and that at 1 month postoperatively indicates the likelihood of achievement of the goal of knee flexion ROM at 12 months after TKA.
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Affiliation(s)
- Tomohiro Oka
- Department of Rehabilitation, Anshin Hospital.,Department of Public Health, Kobe University Graduate School of Health Sciences
| | - Osamu Wada
- Department of Rehabilitation, Anshin Hospital
| | - Tsuyoshi Asai
- Department of Medical Rehabilitation, Faculty of Rehabilitation, Kobe Gakuin University
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10
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Changes in knee range of motion after large osteochondral allograft transplantations. Knee 2021; 28:207-213. [PMID: 33418396 DOI: 10.1016/j.knee.2020.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/16/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our study purpose was to determine if primary osteochondral allograft (OCA) transplant surgeries for large (>4 cm2) single-surface, multisurface, or bipolar articular defects in the knee would be associated with significant gains in knee range of motion (ROM) at ≥1-year follow-up when compared to preoperative ROM. METHODS Patients were prospectively enrolled into a dedicated registry to follow outcomes after OCA with or without meniscal allograft transplantation using Missouri Osteochondral Preservation System (MOPS)-preserved allografts. Patients were included if they had surgery to repair at least one osteochondral defect, and when at least one year of ROM data and Visual Analog Scale pain scores were available. Data on complications and reoperations, patient-reported outcome measures, compliance with rehabilitation, revisions, or failures were recorded. RESULTS For patients who met inclusion criteria after OCA surgery (n = 75), overall ROM increased from 127.8 ± 17 degrees preoperatively, to 130.5 ± 14 post-operatively. Non-compliance was the largest factor contributing to postoperative ROM lag or loss. Knee manipulation/lysis of adhesion rates were comparable to rates in TKA and ACL procedures (2.96-4.54% for ACL/TKA, 4% for OCAs in the present study). CONCLUSION Results suggest that OCA with or without meniscal allograft transplantation in the knee using high-viability grafts, advanced graft cutting and implantation techniques, and procedure-specific rehabilitation protocols can result in consistently successful outcomes in a high percentage (92%) of selected patients. Most patients (95%) can expect to regain, or improve, to "full" functional range of motion (130°) at 1 year after surgery such that highly functional activities can be performed. LEVEL OF EVIDENCE Cohort study; Level III.
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11
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Haverkamp D, van der Vis HM, Lee J, Achan P, Sierevelt IN, Ramachandran M. Two-year clinical results of a novel load redistribution device for the treatment of medial knee OA. Arch Orthop Trauma Surg 2020; 140:1873-1881. [PMID: 32128630 DOI: 10.1007/s00402-020-03390-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE A potential method to relieve the pain from medial osteoarthritis of the knee is to offload the medial compartment. The Latella™ Knee Implant is a novel device designed to offload the medial compartment. The objective of the Cotera-1 study was to evaluate the preliminary safety and feasibility of the Latella implant to treat patients with medial OA of the knee, by a 2-year follow-up of a prospective multicenter feasibility study (Cotera-1) performed in the Netherlands and UK METHODS: In this first-in-man study, 11 participants received the Latella implant and were followed for 2 years, documenting physician assessment, Patient-Reported Outcome (PRO) scoring (KOOS, IKDC, Kujala, SF-36); Patient Global Assessment (PGA), radiographic analysis and MRI analysis, complications, reoperation rate and hip-knee-ankle axis. RESULTS The Latella Knee Implant system proved to be well tolerated and demonstrated a low-risk safety profile up to 24 months post-treatment. A responder analysis was performed of the subjects who still had the Latella implanted at 24-month time point (n = 9). Based on a MCID of eight for KOOS pain sub-scale, 78% of the subjects at the 24 month time point would be considered as responders. Similarly, based on improvement in the medial knee pain compared to baseline using the NRS scale of 1-10, 89% of the subjects at the 24-month time point would be considered as responders. Two patients were revised during follow-up: one for arthrofibrosis and one converted to TKA for progression of OA. CONCLUSIONS The early clinical experience with the Latella Knee Implant in this pilot feasibility study has been encouraging. It appears to be a safe implant with possible effect on medial OA. Additional studies need to be performed to assess the safety and efficacy of the procedure in a larger patient population. LEVEL OF EVIDENCE II.
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Affiliation(s)
- D Haverkamp
- Xpert Orthopedie, Laarderhoogtweg 12, 1101 AE, Amsterdam, The Netherlands.
| | - H M van der Vis
- Xpert Orthopedie, Laarderhoogtweg 12, 1101 AE, Amsterdam, The Netherlands
| | - J Lee
- Barts Health NHS Trust, London, UK.,The Royal London Hospital, Whitechapel, London, E1 1BB, UK
| | - P Achan
- Barts Health NHS Trust, London, UK.,The Royal London Hospital, Whitechapel, London, E1 1BB, UK
| | - I N Sierevelt
- Xpert Orthopedie, Laarderhoogtweg 12, 1101 AE, Amsterdam, The Netherlands
| | - M Ramachandran
- Barts Health NHS Trust, London, UK.,The Royal London Hospital, Whitechapel, London, E1 1BB, UK
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Blyth MJG, Anthony I, Rowe P, Banger MS, MacLean A, Jones B. Robotic arm-assisted versus conventional unicompartmental knee arthroplasty: Exploratory secondary analysis of a randomised controlled trial. Bone Joint Res 2017; 6:631-639. [PMID: 29162608 PMCID: PMC5717071 DOI: 10.1302/2046-3758.611.bjr-2017-0060.r1] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives This study reports on a secondary exploratory analysis of the early clinical outcomes of a randomised clinical trial comparing robotic arm-assisted unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis of the knee with manual UKA performed using traditional surgical jigs. This follows reporting of the primary outcomes of implant accuracy and gait analysis that showed significant advantages in the robotic arm-assisted group. Methods A total of 139 patients were recruited from a single centre. Patients were randomised to receive either a manual UKA implanted with the aid of traditional surgical jigs, or a UKA implanted with the aid of a tactile guided robotic arm-assisted system. Outcome measures included the American Knee Society Score (AKSS), Oxford Knee Score (OKS), Forgotten Joint Score, Hospital Anxiety Depression Scale, University of California at Los Angeles (UCLA) activity scale, Short Form-12, Pain Catastrophising Scale, somatic disease (Primary Care Evaluation of Mental Disorders Score), Pain visual analogue scale, analgesic use, patient satisfaction, complications relating to surgery, 90-day pain diaries and the requirement for revision surgery. Results From the first post-operative day through to week 8 post-operatively, the median pain scores for the robotic arm-assisted group were 55.4% lower than those observed in the manual surgery group (p = 0.040). At three months post-operatively, the robotic arm-assisted group had better AKSS (robotic median 164, interquartile range (IQR) 131 to 178, manual median 143, IQR 132 to 166), although no difference was noted with the OKS. At one year post-operatively, the observed differences with the AKSS had narrowed from a median of 21 points to a median of seven points (p = 0.106) (robotic median 171, IQR 153 to 179; manual median 164, IQR 144 to 182). No difference was observed with the OKS, and almost half of each group reached the ceiling limit of the score (OKS > 43). A greater proportion of patients receiving robotic arm-assisted surgery improved their UCLA activity score. Binary logistic regression modelling for dichotomised outcome scores predicted the key factors associated with achieving excellent outcome on the AKSS: a pre-operative activity level > 5 on the UCLA activity score and use of robotic-arm surgery. For the same regression modelling, factors associated with a poor outcome were manual surgery and pre-operative depression. Conclusion Robotic arm-assisted surgery results in improved early pain scores and early function scores in some patient-reported outcomes measures, but no difference was observed at one year post-operatively. Although improved results favoured the robotic arm-assisted group in active patients (i.e. UCLA ⩾ 5), these do not withstand adjustment for multiple comparisons. Cite this article: M. J. G. Blyth, I. Anthony, P. Rowe, M. S. Banger, A. MacLean, B. Jones. Robotic arm-assisted versus conventional unicompartmental knee arthroplasty: Exploratory secondary analysis of a randomised controlled trial. Bone Joint Res 2017;6:631–639. DOI: 10.1302/2046-3758.611.BJR-2017-0060.R1.
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Affiliation(s)
- M J G Blyth
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - I Anthony
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - P Rowe
- University of Strathclyde, Glasgow, G1 1XQ, UK
| | - M S Banger
- University of Strathclyde, Glasgow, G1 1XQ, UK
| | - A MacLean
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - B Jones
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
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van der Ven PJP, van de Groes S, Zelle J, Koëter S, Hannink G, Verdonschot N. Kneeling and standing up from a chair as performance-based tests to evaluate knee function in the high-flexion range: a randomized controlled trial comparing a conventional and a high-flexion TKA design. BMC Musculoskelet Disord 2017; 18:324. [PMID: 28764691 PMCID: PMC5540509 DOI: 10.1186/s12891-017-1657-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022] Open
Abstract
Background We compared the functional outcome between conventional and high-flexion total knee arthroplasty (TKA) using kneeling and sit-to-stand tests at 1 year post-operative. In addition, the patient’s daily functioning, pain and satisfaction were quantified using questionnaires. Methods We randomly assigned 56 patients to receive either a conventional or a high-flexion TKA. Primary outcomes were maximum flexion angle and maximum thigh-calf contact measured during kneeling at 1 year post operatively. Secondary outcomes were the angular knee velocity and ground reaction force ratio measured during sit-to-stand performance tests, and questionnaires. Results At one year post-operative, maximum knee flexion during kneeling was higher for the high-flexion TKA group (median 128.02° (range 108–146)) compared to the conventional TKA group (119.13° (range 72–135)) (p = 0.03). Maximum thigh-calf contact force was higher for the high flexion TKA group (median 17.82 N (range 2.98–114.64)) compared to the conventional TKA group (median 9.37 N (range 0.33–46.58))(p = 0.04). The sit-to-stand tests showed a significantly higher angular knee velocity in the conventional TKA group (12.12 rad/s (95%CI 0.34–23.91); p = 0.04). There were no significant differences between groups in ground reaction force ratios and patient-reported outcome scores. Conclusion Although no differences were found in patient-reported outcome scores, differences in performance-based tests were clearly apparent. Standing up from a chair at 90° of knee flexion appeared to be easier for the conventional group. The kneeling test revealed significantly higher weight-bearing knee flexion for the high-flex group. Hence, if kneeling is an important activity for a patient a high-flex design may be recommendable. Trial registration The study was retrospectively registered in ClinicalTrials.gov under identifier NCT00899041 (date of registration: May 11, 2009).
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Affiliation(s)
- Paul J P van der Ven
- 611 Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Sebastiaan van de Groes
- 611 Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Jorrit Zelle
- 611 Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Sander Koëter
- Department of Orthopaedics, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Gerjon Hannink
- 611 Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Nico Verdonschot
- 611 Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands. .,Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands.
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Patients with total knee arthroplasty do not use all of their available range of knee flexion during functional activities. Clin Biomech (Bristol, Avon) 2017; 43:74-78. [PMID: 28213168 DOI: 10.1016/j.clinbiomech.2017.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent research designed to improve outcome from total knee arthroplasty has included focus on strategies that increase the range of post-operative knee flexion. Patients with knee arthroplasty can now expect >100° of knee flexion following surgery, but it is not clear whether this improved range of motion facilitates outcome or whether patients take advantage of this range when completing daily functional activities. The aim of this study was to investigate the knee flexion angles used during daily functional activities that specifically required high degrees of knee flexion. It was hypothesised that patients with greater range of passive knee flexion would achieve higher degrees of knee flexion during functional activities. METHODS Motion analysis was used to assess the maximum knee flexion of 40 patients with total knee arthroplasty and 40 control participants as they performed maximum flexion squatting and lunging activities. FINDINGS Patients with knee arthroplasty used between 80.8 and 91.4° of knee flexion to complete these activities, which was 20 to 30% less than that used by the control participants. Patients with greater ranges of passive knee flexion had greater maximum knee flexion during functional activities. However, they used only between 68% and 77% of their full passive range when lunging and squatting. INTERPRETATION The development of rehabilitation strategies that aim to increase weightbearing knee flexion capacity may be warranted to improve functional performance following total knee arthroplasty.
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Ha CW, Park YB, Song YS, Kim JH, Park YG. Increased Range of Motion Is Important for Functional Outcome and Satisfaction After Total Knee Arthroplasty in Asian Patients. J Arthroplasty 2016; 31:1199-1203. [PMID: 26777578 DOI: 10.1016/j.arth.2015.12.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/19/2015] [Accepted: 12/01/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although range of motion (ROM) is considered as an important factor for good outcome after total knee arthroplasty (TKA), the association of the degree of ROM with functional outcome and patient satisfaction is debated. We, therefore, investigated whether increased ROM would affect functional outcome and patient satisfaction after TKA in Asian patients. METHODS We reviewed 630 patients who underwent primary TKA with minimum 2-year follow-up. Clinical outcomes were evaluated by Knee Society (KS) score, Western Ontario and McMaster Universities osteoarthritis index, and high-flexion knee score. Patient satisfaction was evaluated using a validated questionnaire. The association of ROM and change in ROM (cROM) with clinical outcomes and satisfaction were analyzed using partial correlation analysis and multiple median regression analysis. RESULTS All functional scores showed significant correlation with postoperative ROM (r = 0.129, P = .001 in Knee Society score; r = -0.101, P = .012 in Western Ontario and McMaster Universities osteoarthritis index; r = 0.183, P < .001 in high-flexion knee score). cROM correlated with satisfaction (r = 0.192, P = .005). Postoperative ROM and cROM were revealed as predisposing factors affecting function outcome using multivariable regression analysis. cROM was found as a predisposing factor affecting satisfaction. CONCLUSIONS Based on the results of this study, ROM positively associated with functional outcome and cROM positively associated with patient satisfaction after TKA. These findings suggest that increased ROM after TKA is an important factor for functional outcome and satisfaction in Asian patients.
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Affiliation(s)
- Chul-Won Ha
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong-Beom Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Suk Song
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong-Geun Park
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju-si, South Korea
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Are the Current Outcome Measurement Tools Appropriate for the Evaluation of the Knee Status in Deep Flexion Range? J Arthroplasty 2016; 31:87-91. [PMID: 26254509 DOI: 10.1016/j.arth.2015.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 05/19/2015] [Accepted: 07/06/2015] [Indexed: 02/01/2023] Open
Abstract
We determined whether current outcome measurement tools are appropriate for the evaluation of the knee status in deep flexion range after TKA. Patients (n = 604) with more than 120° of knee flexion were evaluated by Knee Society score, WOMAC, and high flexion knee score (HFKS). The appropriateness of measurement tools was analyzed by correlation analyses and group comparisons (group 1: 120°-129°, group 2: 130°-139°, group 3: 140°-150°). HFKS showed stronger correlation with knee flexion compared with other scores. While other scores only differentiated between groups 2 and 3, HFKS could differentiate among groups 1, 2 and 3. These findings suggest that employment of proper outcome measurement tool is needed to evaluate and differentiate the knee status in deep flexion range after TKA.
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Nutton RW, Wade FA, Coutts FJ, van der Linden ML. Does a mobile-bearing, high-flexion design increase knee flexion after total knee replacement? ACTA ACUST UNITED AC 2012; 94:1051-7. [PMID: 22844045 DOI: 10.1302/0301-620x.94b8.28828] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This prospective randomised controlled double-blind trial compared two types of PFC Sigma total knee replacement (TKR), differing in three design features aimed at improving flexion. The outcome of a standard fixed-bearing posterior cruciate ligament-preserving design (FB-S) was compared with that of a high-flexion rotating-platform posterior-stabilised design (RP-F) at one year after TKR. The study group of 77 patients with osteoarthritis of the knee comprised 37 men and 40 women, with a mean age of 69 years (44.9 to 84.9). The patients were randomly allocated either to the FB-S or the RP-F group and assessed pre-operatively and at one year post-operatively. The mean post-operative non-weight-bearing flexion was 107° (95% confidence interval (CI) 104° to 110°)) for the FB-S group and 113° (95% CI 109° to 117°) for the RP-F group, and this difference was statistically significant (p = 0.032). However, weight-bearing range of movement during both level walking and ascending a slope as measured during flexible electrogoniometry was a mean of 4° lower in the RP-F group than in the FB-S group, with 58° (95% CI 56° to 60°) versus 54° (95% CI 51° to 57°) for level walking (p = 0.019) and 56° (95% CI 54° to 58°) versus 52° (95% CI 48° to 56°) for ascending a slope (p = 0.044). Further, the mean post-operative pain score of the Western Ontario and McMaster Universities Osteoarthritis Index was significantly higher in the RP-F group (2.5 (95% CI 1.5 to 3.5) versus 4.2 (95% CI 2.9 to 5.5), p = 0.043). Although the RP-F group achieved higher non-weight-bearing knee flexion, patients in this group did not use this during activities of daily living and reported more pain one year after surgery.
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Affiliation(s)
- R W Nutton
- Royal Infirmary Edinburgh, Orthopaedics Department, 51 Little France Crescent, Edinburgh EH16 4SA, UK
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Herbold JA, Bonistall K, Blackburn M. Effectiveness of Continuous Passive Motion in an Inpatient Rehabilitation Hospital After Total Knee Replacement: A Matched Cohort Study. PM R 2012; 4:719-25. [DOI: 10.1016/j.pmrj.2012.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 06/22/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022]
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An Eccentrically Biased Rehabilitation Program Early after TKA Surgery. ARTHRITIS 2011; 2011:353149. [PMID: 22046514 PMCID: PMC3195282 DOI: 10.1155/2011/353149] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/10/2011] [Accepted: 02/17/2011] [Indexed: 01/01/2023]
Abstract
Rehabilitation services are less-studied aspects of the management following total knee arthroplasty (TKA) despite long-term suboptimal physical functioning and chronic deficits in muscle function. This paper describes the preliminary findings of a six-week (12 session) eccentrically-biased rehabilitation program targeted at deficits in physical function and muscle function, initiated one month following surgery. A quasiexperimental, one group, pretest-posttest study with thirteen individuals (6 female, 7 male; mean age 57 ± 7 years) examined the effectiveness of an eccentrically-biased rehabilitation program. The program resulted in improvements in the primary physical function endpoints (SF-36 physical component summary and the six-minute walk test) with increases of 59% and 47%, respectively. Muscle function endpoints (knee extension strength and power) also increased 107% and 93%, respectively. Eccentrically-biased exercise used as an addition to rehabilitation may help amplify and accelerate physical function following TKA surgery.
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Devers BN, Conditt MA, Jamieson ML, Driscoll MD, Noble PC, Parsley BS. Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty? J Arthroplasty 2011; 26:178-86. [PMID: 20413247 DOI: 10.1016/j.arth.2010.02.008] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 02/19/2010] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine whether high flexion leads to improved benefits in patient satisfaction, perception, and function after total knee arthroplasty (TKA). Data were collected on 122 primary TKAs. Patients completed a Total Knee Function Questionnaire. Knees were classified as low (≤ 110°), mid (111°-130°), or high flexion (>130°). Correlation between knee flexion and satisfaction was not statistically significant. Increased knee flexion had a significant positive association with achievement of expectations, restoration of a "normal" knee, and functional improvement. In conclusion, although the degree of postoperative knee flexion did not affect patient satisfaction, it did influence fulfillment of expectations, functional ability, and knee perception. This suggests that increased knee flexion, particularly more than 130°, may lead to improved outcomes after TKA.
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Lower limbs function and pain relationships after unilateral total knee arthroplasty. Int J Rehabil Res 2010; 33:264-7. [DOI: 10.1097/mrr.0b013e3283352126] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Normal functional range of motion of the lumbar spine during 15 activities of daily living. ACTA ACUST UNITED AC 2010; 23:106-12. [PMID: 20065869 DOI: 10.1097/bsd.0b013e3181981823] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective clinical study. OBJECTIVE The purpose of this investigation was to quantify normal lumbar range of motion (ROM) and compare these results with those used to perform 15 simulated activities of daily living (ADLs) in asymptomatic subjects. SUMMARY OF BACKGROUND DATA Previous studies reporting the ROM of the lumbar spine during ADLs have been limited, only focusing on 4 ADLs. The purpose of this investigation was to quantify the extent of normal lumbar ROM and determine how much motion is necessary to perform 15 simulated ADLs. METHODS A noninvasive electrogoniometer and torsiometer were used to measure the ROM of the lumbar spine. The accuracy and reliability of the devices were confirmed by comparing the ROM values acquired from dynamic flexion/extension and lateral bending radiographs with those provided by the device that was activated while the radiographs were obtained. Intraobserver reliability was established by calculating the intraclass correlation coefficient for repeated measurements on the same subjects by 1 investigator on consecutive days. These tools were employed in a clinical laboratory setting to evaluate the full active ROM of the lumbar spines (ie, flexion/extension, lateral bending, and axial rotation) of 60 asymptomatic subjects (30 women and 30 men; age 20 to 75 y) and to assess the functional ROM required to complete 15 simulated ADLs. RESULTS When compared with radiographic measurements, the electrogoniometer was found to be accurate within 2.3+/-2.6 degrees (mean+/-SD). The intraobserver reliabilities for assessing full and functional ROM were both excellent (intraclass correlation coefficient of 0.96 and 0.88, respectively). The absolute ROM and percentage of full active lumbar spinal ROM used during the 15 ADLs was 3 to 49 degrees and 4% to 59% (median: 9 degrees/11%) for flexion/extension, 2 to 11 degrees and 6% to 31% (6 degrees/17%) for lateral bending, and 2 to 7 degrees and 6% to 20% (5 degrees/13%) for rotation. Picking up an object from the ground, either using a bending or squatting technique, required the most ROM of all the ADLs. Squatting required a significantly less amount of sagittal motion compared with bending at the waist (42 vs. 48 degrees, P=0.003). No difference was seen in both lateral and rotation motion between these 2 techniques (11 vs. 11 degrees and 6 vs. 6 degrees, respectively). Both ascending and descending stairs required equivalent amounts of total motion in all 3 motion planes. As a whole, personal hygiene ADLs (hand washing, washing hair, shaving, and make-up application) required a similar amount of motion compared with the 3 locomotive ADLs (walking, up and down stairs). CONCLUSIONS By quantifying the amounts of lumbar motion required to execute a series of simulated ADLs, this study indicates that most individuals use a relatively small percentage of their full active ROM when performing such activities. These findings provide baseline data that may allow clinicians to accurately assess preoperative impairment and postsurgical outcomes.
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Normal Functional Range of Motion of the Cervical Spine During 15 Activities of Daily Living. ACTA ACUST UNITED AC 2010; 23:15-21. [PMID: 20051924 DOI: 10.1097/bsd.0b013e3181981632] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Indramohan VP, Valsan G, Rowe PJ. Development and validation of a user-friendly data logger (SUDALS) for use with flexible electrogoniometers to measure joint movement in clinical trials. J Med Eng Technol 2009; 33:650-5. [DOI: 10.3109/03091900903159403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Unver B, Karatosun V, Bakirhan S. Reliability of Goniometric Measurements of Flexion in Total Knee Arthroplasty Patients: with Special Reference to the Body Position. J Phys Ther Sci 2009. [DOI: 10.1589/jpts.21.257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylül University
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Long WJ, Scuderi GR. High-flexion total knee arthroplasty. J Arthroplasty 2008; 23:6-10. [PMID: 18922369 DOI: 10.1016/j.arth.2008.06.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 06/17/2008] [Indexed: 02/01/2023] Open
Abstract
High-flexion total knee arthroplasty is considered flexion beyond 125 degrees . Certain activities and a number of workplace demands benefit from this greater range of motion. Some cultures and religions place more emphasis on deep knee flexion. Important patient factors include preoperative motion, body mass index, and previous knee surgery. Component design modifications focus on lengthening the radius of curvature through the posterior condyles, increasing the posterior condylar offset, recessing the tibial insert, lengthening the trochlear groove, and altering the cam-post design. These changes allow increased femoral rollback, translation, and thus clearance in deep flexion. Surgical techniques focus on soft tissue balancing, component sizing and position, removal of impinging osteophytes, and reestablishment of the flexion gap. A number of outcome studies have demonstrated benefits for high flexion after standard total knee and high-flexion designs.
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Affiliation(s)
- William J Long
- Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, New York 10065, USA
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Unver B, Karatosun V, Bakirhan S. Effects of obesity on inpatient rehabilitation outcomes following total knee arthroplasty. Physiotherapy 2008. [DOI: 10.1016/j.physio.2007.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Mihalko W, Fishkin Z, Krackow K, Krakow K. Patellofemoral overstuff and its relationship to flexion after total knee arthroplasty. Clin Orthop Relat Res 2006; 449:283-7. [PMID: 16888532 DOI: 10.1097/01.blo.0000218756.89439.06] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Flexion is an important outcome variable after total knee arthroplasty. Traditionally, matched implant-bone resections of the distal and posterior aspects of the femur are used to prevent loss of knee flexion or extension. However, given limited implant sizes, resection of these portions of the femur may affect the shape of the knee. Variations in the anterior aspects of the femur along with implant size constraints may increase trochlear groove height in the anterior compartment, increase the arc that the extensor mechanism must travel, and thereby decrease passive flexion. We determined the trochlear groove height change in 55 patients after primary total knee arthroplasties. The thickness of the replaced lateral and medial anterior flanges increased by 1.1 +/- 2.6 mm and 0.5 +/- 2.2 mm, respectively, whereas the change in trochlear groove thickness was 0 +/- 1.1 mm. We examined varying amounts of patellofemoral buildup in a cadaver model to observe the effect on passive range of motion of the knee. A 2-mm and 4-mm buildup of the anterior cortex resulted in flexion loss of 1.8 degrees and 4.4 degrees, respectively. The change in the shape of the anterior aspect of the femur may have small effects on flexion but they may not be clinically important.
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Affiliation(s)
- William Mihalko
- Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA.
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