The Early Clinical Outcome of High-flexion <i>versus</i> Standard Prostheses in Total Knee Arthroplasty_West China Medical Journal

Authors：

 YANBing , WANGYong-cai , WANGHong-chuan , LIUKai , JIANGJun-wei

Department of Orthopedics, People's Hospital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

Keywords：

Total knee arthroplasty; High-flexion prostheses; Curative effect

DOI：

10.7507/1002-0179.20150250

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Objective To compare the early clinical outcome of GenesisⅡ high-flexion versus standard prostheses in total knee arthroplasty (TKA), and evaluate whether high-flexion prostheses can improve the postoperative range of motion (ROM). Methods Between September 2007 and December 2011, 80 patients (85 knees) consecutively underwent posterior cruciate-sacrificing TKA with GenesisⅡ systems. Finally, we reviewed 60 patients (60 knees) including 32 knees in high-flexion group and 28 knees in standard group. The follow-up time was 2.7 years in average. The postoperative knee ROM and the rate of complication of the two groups were evaluated. Results The mean postoperative knee ROM of 32 knees was 112.8° in the high-flexion group and was 108.9° in the standard group. The mean postoperative HSS score was 86.6 and 84.2, respectively. The postoperative knee ROM, hospital for special surgery (HSS) score and the rate of complication did not show significant difference between the two groups. Conclusion The high-flexion prosthesis is no better than the ordinary prosthesis in terms of the range of motion. We need more mid to long-term studies to do further research.

Citation： YANBing, WANGYong-cai, WANGHong-chuan, LIUKai, JIANGJun-wei. The Early Clinical Outcome of High-flexion versus Standard Prostheses in Total Knee Arthroplasty. West China Medical Journal, 2015, 30(5): 869-872. doi: 10.7507/1002-0179.20150250 Copy

1.	Banks S, Bellemans J, Nozaki H, et al. Knee motions during maximum flexion in fixed and mobile-bearing arthroplasties[J]. Clin Orthop Relat Res, 2003(410):131-138.
2.	曾羿. 高屈曲度膝关节假体实现高屈曲了吗?[J]. 中国骨与关节外科, 2013, 6(1):80-82, 79.
3.	Hanratty BM, Thompson NW, Wilson RK, et al. The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant[J]. J Bone Joint Surg Br, 2007, 89(7):915-918.
4.	Ewald FC. The knee society total knee arthroplasty roentgenographic evaluation and scoring system[J]. Clin Orthop Relat Res, 1989(248):9-12.
5.	Gomes LS, Bechtold JE, Gustilo RB. Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study[J]. Clin Orthop Relat Res, 1988(236):72-81.
6.	曾勉东, 杨波, 谢景开, 等. 影响全膝关节置换术后关节活动度的相关因素分析[J]. 中国骨与关节损伤杂志, 2012, 27(10):887-889.
7.	Suggs JF, Kwon YM, Durbhakula SM, et al. In vivo flexion and kinematics of the knee after TKA:comparison of a conventional and a high flexion cruciate-retaining TKA design[J]. Knee Surg Sports Traumatol Arthrosc, 2009, 17(2):150-156.
8.	Malik A, Salas A, Ben Ari J, et al. Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts[J]. Int Orthop, 2010, 34(7):965-972.
9.	Seon JK, Park SJ, Lee KB, et al. Range of motion in total knee arthroplasty:a prospective comparison of high-flexion and standard cruciate-retaining designs[J]. J Bone Joint Surg Am, 2009, 91(3):672-679.
10.	Minoda Y, Aihara M, Sakawa A, et al. Range of motion of standard and high-flexion cruciate retaining total knee prostheses[J]. J Arthroplasty, 2009, 24(5):674-680.
11.	Gupta SK, Ranawat AS, Shah V, et al. The PFC sigma RP-F TKA designed for improved performance:a matched-pair study[J]. Orthopedics, 2006, 29(9 Suppl):S49-S52.
12.	Thomsen MG, Husted H, Otte KS, et al. Do patients care about higher flexion in total knee arthroplasty? A randomized, controlled, double-blinded trial[J]. BMC Musculoskelet Disord, 2013, 14(1):127.
13.	Fu H, Wang J, Zhang W, et al. No clinical benefit of high-flex total knee arthroplasty. A meta-analysis of randomized controlled trials[J/OL]. J arthroplasty, 2014. Doi:10.1016/j.arth.2014.10.032.
14.	彭慧明, 刘家明, 翁习生, 等. 高屈曲假体初次全膝关节置换术早期随访结果的Meta分析[J]. 中华骨科杂志, 2010, 30(6):548-553.
15.	Gandhi R, Tso P, Davey JR, et al. High-flexion implants in primary total knee arthroplasty:a meta-analysis[J]. Knee, 2009, 16(1):14-17.
16.	Massin P, Gournay A. Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty[J]. J Arthroplasty, 2006, 21(6):889-896.
17.	Mccalden RW, Macdonald SJ, Bourne RB. A randomized controlled trial comparing high-flex vs standard posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty reply[J]. J Arthroplasty, 2010, 25(3):499.
18.	Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement[J]. J Bone Joint Surg Br, 2007, 89(11):1457-1461.

1. Banks S, Bellemans J, Nozaki H, et al. Knee motions during maximum flexion in fixed and mobile-bearing arthroplasties[J]. Clin Orthop Relat Res, 2003(410):131-138.
2. 曾羿. 高屈曲度膝关节假体实现高屈曲了吗?[J]. 中国骨与关节外科, 2013, 6(1):80-82, 79.
3. Hanratty BM, Thompson NW, Wilson RK, et al. The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant[J]. J Bone Joint Surg Br, 2007, 89(7):915-918.
4. Ewald FC. The knee society total knee arthroplasty roentgenographic evaluation and scoring system[J]. Clin Orthop Relat Res, 1989(248):9-12.
5. Gomes LS, Bechtold JE, Gustilo RB. Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study[J]. Clin Orthop Relat Res, 1988(236):72-81.
6. 曾勉东, 杨波, 谢景开, 等. 影响全膝关节置换术后关节活动度的相关因素分析[J]. 中国骨与关节损伤杂志, 2012, 27(10):887-889.
7. Suggs JF, Kwon YM, Durbhakula SM, et al. In vivo flexion and kinematics of the knee after TKA:comparison of a conventional and a high flexion cruciate-retaining TKA design[J]. Knee Surg Sports Traumatol Arthrosc, 2009, 17(2):150-156.
8. Malik A, Salas A, Ben Ari J, et al. Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts[J]. Int Orthop, 2010, 34(7):965-972.
9. Seon JK, Park SJ, Lee KB, et al. Range of motion in total knee arthroplasty:a prospective comparison of high-flexion and standard cruciate-retaining designs[J]. J Bone Joint Surg Am, 2009, 91(3):672-679.
10. Minoda Y, Aihara M, Sakawa A, et al. Range of motion of standard and high-flexion cruciate retaining total knee prostheses[J]. J Arthroplasty, 2009, 24(5):674-680.
11. Gupta SK, Ranawat AS, Shah V, et al. The PFC sigma RP-F TKA designed for improved performance:a matched-pair study[J]. Orthopedics, 2006, 29(9 Suppl):S49-S52.
12. Thomsen MG, Husted H, Otte KS, et al. Do patients care about higher flexion in total knee arthroplasty? A randomized, controlled, double-blinded trial[J]. BMC Musculoskelet Disord, 2013, 14(1):127.
13. Fu H, Wang J, Zhang W, et al. No clinical benefit of high-flex total knee arthroplasty. A meta-analysis of randomized controlled trials[J/OL]. J arthroplasty, 2014. Doi:10.1016/j.arth.2014.10.032.
14. 彭慧明, 刘家明, 翁习生, 等. 高屈曲假体初次全膝关节置换术早期随访结果的Meta分析[J]. 中华骨科杂志, 2010, 30(6):548-553.
15. Gandhi R, Tso P, Davey JR, et al. High-flexion implants in primary total knee arthroplasty:a meta-analysis[J]. Knee, 2009, 16(1):14-17.
16. Massin P, Gournay A. Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty[J]. J Arthroplasty, 2006, 21(6):889-896.
17. Mccalden RW, Macdonald SJ, Bourne RB. A randomized controlled trial comparing high-flex vs standard posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty reply[J]. J Arthroplasty, 2010, 25(3):499.
18. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement[J]. J Bone Joint Surg Br, 2007, 89(11):1457-1461.

West China Medical Journal

The Early Clinical Outcome of High-flexion versus Standard Prostheses in Total Knee Arthroplasty

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