2009 Marshall Urist Young Investigator Award: How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?

Abstract

Although high-flexion TKA designs aim to safely accommodate deep flexion, it is unknown how often patients use deep flexion outside the laboratory. We used a validated smart-activity monitor to document the prevalence of knee flexion greater than 90°in 20 consecutive patients (21 knees) who had high-flexion TKAs, at a minimum of 2 years' followup. Patients wore the device continuously for a mean of 35.7 ± 0.5 hours. The 21 knees flexed more than 90°for an average of 10 ± 3.8 minutes (0.5%). Activities performed with flexion greater than 90°w ere, on average, 70% in single-limb stance, 12% moving from sitting to standing, 8% walking, 7% moving from standing to reclining, 2% stepping, 0.9% moving from lying to standing, and 0.1% running. Eight knees flexed greater than 120°for an average of 2.2 minutes (range, 0.2-15 minutes), or 0.1% of the testing time. Activities performed with flexion greater than 120°were, on average, 90% in single-limb stance, 6% moving from sitting to standing, 3% walking, 0.6% moving from standing to reclining, 0.3% stepping, and 0.1% moving from lying to standing. Peak flexion used at any time during testing was, on average, 84%

A New High-flexion Knee Scoring System to Eliminate the Ceiling Effect

“…Furthermore, it also places less focus on more active patients in terms of delineating small functional differences in high-functional activities. Improvements in surgical technique and implant design have enabled some patients to regain knee function, even in the high-function range after TKA [9,10,15]. Further, with the improvements the indications have expanded to include younger patients with expectations of high function and high flexion.…”

Ten-Year Outcome Comparison of the Anatomical Graduated Component and Vanguard Total Knee Arthroplasty Systems

“…These evolutionary changes have been made with the intent of developing implants with better overall function and durability. Many possible advantages have been proposed and incorporated in other designs to address concerns with TKA success in everyday use [4][5][6][7][8]. In an attempt to achieve these goals, an evolutionary design (Vanguard, Biomet Inc, Warsaw, IN) was developed to replace a very successful implant (AGC, Biomet Inc, Warsaw, IN) [1][2][3].…”

Rango de movilidad y resultados funcionales en tres diseños diferentes de artroplastia de rodilla primaria. Estudio Comparativo. [Range of motion and functional results in three different designs of total knee arthroplasty].

“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] En una revisión sistemática conducida por Murphy y cols., que incluyó nueve estudios y 399 prótesis de alta flexión en 370 pacientes, focalizada en estudiar los resultados de las prótesis de alta flexión, se comunica la falta de evidencia para determinar que las prótesis de alta flexión mejorarían el rango de movilidad y el desempeño funcional de los pacientes. 38 Un metanálisis publicado en 2009 muestra resultados a favor de las prótesis de alta flexión comparadas con las convencionales, a diferencia de lo publicado en un metanálisis de 2011.…”

“…[14][15][16] La literatura es amplia y controvertida en este tema y los trabajos publicados sobre pacientes con ATR de alta flexión difieren respecto de los resultados logrados en el rango de movilidad. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] El objetivo de este trabajo comparativo fue analizar los resultados funcionales y el rango de movilidad de la rodilla entre tres grupos de pacientes con ATR, utilizando dos diseños de prótesis de alta flexión y un diseño convencional. Cuarenta y dos pacientes fueron tratados con una próte-sis convencional (Zimmer® NexGen® LPS).…”