Comparison of Knee Flexion Degree after High-flexion <i>versus</i> Standard Total Knee Arthroplasty: A Meta-analysis_West China Medical Journal

Authors：

 ZHANGHui-wei ¹ , LIUKai ² , FANYa-ling ¹ , WANGYong-cai ² , YANBing ² , WANGHong-chuan ² ,  JIANGJun-wei ²

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

Corresponding author：

JIANGJun-wei, Email: 285061643@qq.com

Keywords：

High flexion; Total knee arthroplasty; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1002-0179.20150641

Video：

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Objective To compare the knee flexion degree after high-flexion versus standard total knee arthroplasty (TKA). Method Relevant randomized controlled trials on comparison of knee flexion degree after high-flexion versus standard TKA were identified from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure from the establishment of these databases until October 2015. A systematic review was performed to compare knee flexion degree, knee function score and complications between the two types of prostheses. Analyses were conducted using RevMan version 5.2.0 software. Results Twenty-one studies were included in this Meta-analysis. The results showed that the knee flexion degree was higher in high-flexion group than that in the standard group[WMD=2.71°, 95%CI (0.96, 4.46)°, P=0.002]; while the difference was not significant leaving out six low-quality literatures[WMD=0.72°, 95%CI (-0.15, 1.60)°, P=0.10]. There was no significant difference in knee function score between the two groups[WMD=-0.54, 95%CI (-1.34, 0.25), P=0.18]. There was no significant difference in complications between the two groups[OR=0.99, 95%CI (0.53, 1.84), P=0.98]. Conclusions The important finding from the current study is that there is no evidence to support that the use of high-flexion prostheses is superior to the standard prostheses during total knee arthroplasty.

Citation： ZHANGHui-wei, LIUKai, FANYa-ling, WANGYong-cai, YANBing, WANGHong-chuan, JIANGJun-wei. Comparison of Knee Flexion Degree after High-flexion versus Standard Total Knee Arthroplasty: A Meta-analysis. West China Medical Journal, 2015, 30(12): 2230-2237. doi: 10.7507/1002-0179.20150641 Copy

1.	Bellemans J, Banks S, Victor J, et al. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty[J]. J Bone Joint Surg Br, 2002, 84(1):50-53.
2.	罗世兴, 赵劲民, 苏伟, 等. 高屈曲型与传统假体全膝置换对关节活动度影响的Meta分析[J]. 中国矫形外科杂志, 2011, 19(19):1592-1595.
3.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials, 1996, 17(1):1-12.
4.	Kim TH, Lee DH, Bin SI. The LPS-flex to the knee prosthesis ata minimum of three years[J]. J Bone Joint Surg Br, 2008, 90(10):1304-1310.
5.	Weeden SH, Schmidt R. A randomized, prospective study of primary total knee components designed for increased flexion[J]. J Arthroplasty, 2007, 22(3):349-352.
6.	Nutton RW, van der Linden ML, Rowe PJ, et al. A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components[J]. J Bone Joint Surg Br, 2008, 90(1):37-42.
7.	Ahmed I, Gray AC, van der Linden M, et al. Range of flexion after primary TKA:the effect of soft tissue release and implant design[J]. Orthopedics, 2009, 32(11):811.
8.	Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study[J]. J Bone Joint Surg Am, 2005, 87(7):1470-1475.
9.	Mccalden RW, Macdonald SJ, Bourne RB, et al. A randomized controlled trial comparing "high-flex" vs "standard" posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty[J]. J Arthroplasty, 2009, 24(6 Suppl):33-38.
10.	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.
11.	Wohlrab D, Hube R, Zeh A, et al. Clinical and radiological results of high flex total knee arthroplasty:a 5 year follow-up[J]. Arch Orthop Trauma Surg, 2009, 129(1):21-24.
12.	Nutton RW, Wade FA, Coutts FJ, et al. Does a mobile-bearing, high-flexion design increase knee flexion after total knee replacement?[J]. J Bone Joint Surg Br, 2012, 94(8):1051-1057.
13.	Hamilton WG, Sritulanondha S, Engh CA. Prospective randomized comparison of high-flex and standard rotating platform total knee arthroplasty[J]. J Arthroplasty, 2011, 26(6 Suppl):28-34.
14.	Fischer M, von Eisenhart-Rothe R, Simank HG. Comparable short-term results seen with standard and high-flexion knee arthroplasty designs in European patients[J]. J Orthop, 2013, 10(3):119-122.
15.	白波, 张树栋, 龚姗. 高屈曲度假体与旋转平台假体早期临床疗效比较[J]. 滨州医学院学报, 2011, 34(2):117-119.
16.	Dennis DA, Heekin RD, Clark CR, et al. Effect of implant design on knee flexion[J]. J Arthroplasty, 2013, 28(3):429-438.
17.	Singh H, Mittal V, Nadkarni B, et al. Gender-specific high-flexion knee prosthesis in Indian women:a prospective randomised study[J]. J Orthop Surg (Hong Kong), 2012, 20(2):153-156.
18.	Kim YH, Park JW, Kim JS. High-flexion total knee arthroplasty:survivorship and prevalence of osteolysis:results after a minimum of ten years of follow-up[J]. J Bone Joint Surg Am, 2012, 94(15):1378-1384.
19.	Choi WC, Lee S, Seong SC, et al. Comparison between standard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee arthroplasties:a randomized controlled study[J]. J Bone Joint Surg Am, 2010, 92(16):2634-2642.
20.	石晶磊, 聂少波, 蔡谞, 等. 后稳型旋转平台高屈曲假体与普通假体置换后的膝关节功能比较[J]. 中华骨科杂志, 2011, 31(4):316-320.
21.	Nieuwenhuijse MJ, van der Voort P, Kaptein BL, et al. Fixation of high-flexion total knee prostheses:five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study[J]. J Bone Joint Surg Am, 2013, 95(19):11.
22.	Seng C, Yeo SJ, Wee JL, et al. Improved clinical outcomes after high-flexion total knee arthroplasty:a 5-year follow-up study[J]. J Arthroplasty, 2011, 26(7):1025-1030.
23.	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.
24.	Guild IN 3rd, Labib SA. Clinical outcomes in high flexion total knee arthroplasty were not superior to standard posterior stabilized total knee arthroplasty. A multicenter, prospective, randomized study[J]. J Arthroplasty, 2014, 29(3):530-534.
25.	Mehin R, Burnett RS, Brasher PM. Does the new Generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis[J]. J Bone Joint Surg Br, 2010, 92(10):1429-1434.
26.	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.
27.	程丽. 重度类风湿性膝关节炎全膝关节置换术后的康复训练[J]. 华西医学, 2014, 29(1):124-125.
28.	Boese CK, Gallo TJ, Plantikow CJ. Range of motion and patient satisfaction with traditional and high-flexion rotating-platform knees[J]. Iowa Orthop J, 2011, 31:73-77.

1. Bellemans J, Banks S, Victor J, et al. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty[J]. J Bone Joint Surg Br, 2002, 84(1):50-53.
2. 罗世兴, 赵劲民, 苏伟, 等. 高屈曲型与传统假体全膝置换对关节活动度影响的Meta分析[J]. 中国矫形外科杂志, 2011, 19(19):1592-1595.
3. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J]. Control Clin Trials, 1996, 17(1):1-12.
4. Kim TH, Lee DH, Bin SI. The LPS-flex to the knee prosthesis ata minimum of three years[J]. J Bone Joint Surg Br, 2008, 90(10):1304-1310.
5. Weeden SH, Schmidt R. A randomized, prospective study of primary total knee components designed for increased flexion[J]. J Arthroplasty, 2007, 22(3):349-352.
6. Nutton RW, van der Linden ML, Rowe PJ, et al. A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components[J]. J Bone Joint Surg Br, 2008, 90(1):37-42.
7. Ahmed I, Gray AC, van der Linden M, et al. Range of flexion after primary TKA:the effect of soft tissue release and implant design[J]. Orthopedics, 2009, 32(11):811.
8. Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study[J]. J Bone Joint Surg Am, 2005, 87(7):1470-1475.
9. Mccalden RW, Macdonald SJ, Bourne RB, et al. A randomized controlled trial comparing "high-flex" vs "standard" posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty[J]. J Arthroplasty, 2009, 24(6 Suppl):33-38.
10. 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.
11. Wohlrab D, Hube R, Zeh A, et al. Clinical and radiological results of high flex total knee arthroplasty:a 5 year follow-up[J]. Arch Orthop Trauma Surg, 2009, 129(1):21-24.
12. Nutton RW, Wade FA, Coutts FJ, et al. Does a mobile-bearing, high-flexion design increase knee flexion after total knee replacement?[J]. J Bone Joint Surg Br, 2012, 94(8):1051-1057.
13. Hamilton WG, Sritulanondha S, Engh CA. Prospective randomized comparison of high-flex and standard rotating platform total knee arthroplasty[J]. J Arthroplasty, 2011, 26(6 Suppl):28-34.
14. Fischer M, von Eisenhart-Rothe R, Simank HG. Comparable short-term results seen with standard and high-flexion knee arthroplasty designs in European patients[J]. J Orthop, 2013, 10(3):119-122.
15. 白波, 张树栋, 龚姗. 高屈曲度假体与旋转平台假体早期临床疗效比较[J]. 滨州医学院学报, 2011, 34(2):117-119.
16. Dennis DA, Heekin RD, Clark CR, et al. Effect of implant design on knee flexion[J]. J Arthroplasty, 2013, 28(3):429-438.
17. Singh H, Mittal V, Nadkarni B, et al. Gender-specific high-flexion knee prosthesis in Indian women:a prospective randomised study[J]. J Orthop Surg (Hong Kong), 2012, 20(2):153-156.
18. Kim YH, Park JW, Kim JS. High-flexion total knee arthroplasty:survivorship and prevalence of osteolysis:results after a minimum of ten years of follow-up[J]. J Bone Joint Surg Am, 2012, 94(15):1378-1384.
19. Choi WC, Lee S, Seong SC, et al. Comparison between standard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee arthroplasties:a randomized controlled study[J]. J Bone Joint Surg Am, 2010, 92(16):2634-2642.
20. 石晶磊, 聂少波, 蔡谞, 等. 后稳型旋转平台高屈曲假体与普通假体置换后的膝关节功能比较[J]. 中华骨科杂志, 2011, 31(4):316-320.
21. Nieuwenhuijse MJ, van der Voort P, Kaptein BL, et al. Fixation of high-flexion total knee prostheses:five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study[J]. J Bone Joint Surg Am, 2013, 95(19):11.
22. Seng C, Yeo SJ, Wee JL, et al. Improved clinical outcomes after high-flexion total knee arthroplasty:a 5-year follow-up study[J]. J Arthroplasty, 2011, 26(7):1025-1030.
23. 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.
24. Guild IN 3rd, Labib SA. Clinical outcomes in high flexion total knee arthroplasty were not superior to standard posterior stabilized total knee arthroplasty. A multicenter, prospective, randomized study[J]. J Arthroplasty, 2014, 29(3):530-534.
25. Mehin R, Burnett RS, Brasher PM. Does the new Generation of high-flex knee prostheses improve the post-operative range of movement? A meta-analysis[J]. J Bone Joint Surg Br, 2010, 92(10):1429-1434.
26. 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.
27. 程丽. 重度类风湿性膝关节炎全膝关节置换术后的康复训练[J]. 华西医学, 2014, 29(1):124-125.
28. Boese CK, Gallo TJ, Plantikow CJ. Range of motion and patient satisfaction with traditional and high-flexion rotating-platform knees[J]. Iowa Orthop J, 2011, 31:73-77.

West China Medical Journal

Comparison of Knee Flexion Degree after High-flexion versus Standard Total Knee Arthroplasty: A Meta-analysis

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