Fixed-bearing versus high-flexion RP total knee arthroplasty (TKA): midterm results of a randomized controlled trial

Chaudhry, Amit; Goyal, V. K.

doi:10.1186/s10195-018-0493-z

Cited by 13 publications

(9 citation statements)

References 33 publications

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“…46,47 However, while high flexion designs have improved kinematic outcomes in some patients, these results have not been consistently demonstrated indicating that kinematics are likely driven by factors other than articular shape. [48][49][50] The results of this study support the premise that bony knee shape is not the primary factor determining high flexion knee kinematics.…”

Section: Discussionsupporting

confidence: 68%

Shape is only a weak predictor of deep knee flexion kinematics in healthy and osteoarthritic knees

Lynch

Perriman

Scarvell

et al. 2020

Journal Orthopaedic Research

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Tibiofemoral shape influences knee kinematics but little is known about the effect of shape on deep knee flexion kinematics. The aim of this study was to examine the association between tibiofemoral joint shape and kinematics during deep kneeling in patients with and without osteoarthritis (OA). Sixty‐one healthy participants and 58 patients with end‐stage knee OA received a computed tomography (CT) of their knee. Participants completed full flexion kneeling while being imaged using single‐plane fluoroscopy. Six‐degree‐of‐freedom kinematics were measured by registering a three‐dimensional (3D)‐static CT onto 2D‐dynamic fluoroscopic images. Statistical shape modeling and bivariate functional principal component analysis (bfPCA) were used to describe variability in knee shape and kinematics, respectively. Random‐forest‐regression models were created to test the ability of shape to predict kinematics controlling for body mass index, sex, and group. The first seven modes of the shape model up to three modes of the bfPCAs captured more than 90% of the variation. The ability of the random forest models to predict kinematics from shape was low, with no more than 50% of the variation being explained in any model. Furthermore, prediction errors were high, ranging between 24.2% and 29.4% of the data. Variations in the bony morphology of the tibiofemoral joint were weakly associated with the kinematics of deep knee flexion. The models only explained a small amount of variation in the data with high error rates indicating that additional predictors need to be identified. These results contribute to the clinical understanding of knee kinematics and potentially the expectations placed on high‐flexion total knee replacement design.

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Section: Discussionsupporting

confidence: 68%

Shape is only a weak predictor of deep knee flexion kinematics in healthy and osteoarthritic knees

Lynch

Perriman

Scarvell

et al. 2020

Journal Orthopaedic Research

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“…Eighteen studies (3827 procedures) were included in the comparison of ROM [4, 9, 10, 12, 14, 18, 23, 25, 41, 54, 59, 60, 62, 70, 75, 118]. The MB group demonstrated greater ROM (MD 1.58; 95% CI 0.22 to 2.93; P = 0.02; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty‐two studies (6489 procedures) were included in the comparison of rate of deep infection [4, 7, 13, 14, 17, 23, 25, 33, 35, 36, 39, 41, 42, 55–57, 60–64, 67, 70, 72, 76, 95, 104, 113, 122]. The MB group evidenced a greater rate of deep infections (OR 1.64; 95% CI 1.07 to 2.52; P = 0.02; Fig.…”

Section: Resultsmentioning

confidence: 99%

No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis

Migliorini

Maffulli

Cuozzo

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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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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“…In a mobile bearing, the tibial base metal and the tibial insert can move relative to one another, while the fixed bearing is in a permanent position. The range of flexion between mobile and fixed bearing types has no difference in angle (Chaudhry and Goyal, 2018), however, mobile Frontiers in Mechanical Engineering frontiersin.org bearings make a greater contribution to the rotation angle (Kurita et al, 2012), (Tamaki et al, 2009). Correspondingly, the development of the tibial component of the TKA system by modifying the post-cam mechanism and adjusting the posterior tibial slope provides a significant change in the range of flexion.…”

Section: Figurementioning

confidence: 99%

A review on flexion angle in high-flexion total knee arthroplasty for indonesian’s need

Darmanto

Novriansyah²,

Anggoro³

et al. 2022

Front. Mech. Eng.

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Total Knee Arthroplasty (TKA) proposed as an alternative treatment for damaged knee joints of humans is reviewed. The commercial application of TKA can help patients to improve their daily normal activities. Here the high-flex type total knee arthroplasty (High-Flex TKA) is typically designed for the patient’s convenience on which the greater range of motion can be adjusted for extreme activities such as Seiza and Muslim praying. However, the present High-Flex TKAs have not fulfilled the needs of Indonesians for religious activities with a flexion angle of 150°–165°. Therefore, this review aims to examine the flexion range of High-Flex TKAs proposed for the needs of Indonesians. This study is a narrative review, all studies published and reviewed are related to the range of flexion angles on the use of products from many manufacturers and various types that have been used by patients, as well as the development of a CAD-based TKA design. It was proposed in the present study that the flexion angle on High-Flex TKAs may be optimized by thickening the posterior femoral condyle, creating a medial pivot system, and applying a single radius system on the femoral component. Whereas, the tibial insert component could be designed by setting up the posterior tibial slope, and creating a post-cam stabilizer mechanism. Many knowledge gaps related to the population of research objects, lack of research on extreme angles, development of TKA components, are discussed. Further needs of extensive research on TKA in Mongoloid races are anticipated to be introduced for extreme angles and most comprehensive product development for optimization of the flexion angle.

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Fixed-bearing versus high-flexion RP total knee arthroplasty (TKA): midterm results of a randomized controlled trial

Cited by 13 publications

References 33 publications

Shape is only a weak predictor of deep knee flexion kinematics in healthy and osteoarthritic knees

Shape is only a weak predictor of deep knee flexion kinematics in healthy and osteoarthritic knees

No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis

A review on flexion angle in high-flexion total knee arthroplasty for indonesian’s need

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