High-flexion total knee arthroplasty: a systematic review

Murphy, Michael; Journeaux, S. F.; Russell, Trevor

doi:10.1007/s00264-009-0774-5

Cited by 61 publications

(50 citation statements)

References 51 publications

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“…However, the study comparing a single mobile bearing total knee prosthesis between the high-flexion design and the standard design reported similar results to several studies of fixed bearing design in terms of significantly improved short-term knee ROM and outcome [17]. Although several high-flexion designs of total knee prosthesis, regardless of issue on posterior cruciate ligament or motion of bearing unit, have shown better postoperative knee ROM than those with standard knee designs, a systematic review on results of high-flexion TKA [18] concluded that there was insufficient evidence to support advantages of high-flexion TKA, as many studies had inadequate methodological rigour, such as inadequate blinding, flawed participant selection, short follow-up periods and functional outcomes which lacked sensitivity.…”

Section: Discussionmentioning

confidence: 57%

High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion: outcomes at six years of follow-up

Tanavalee

Ngarmukos

Tantavisut

et al. 2010

International Orthopaedics (SICOT)

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We prospectively evaluated outcomes of highflexion total knee arthroplasty in 165 patients who had advanced arthritis with a minimum 120-degree pre-operative knee flexion, with a mean follow-up of 77 months. Patients were divided into two groups according to their ability to perform full-range (heel-to-buttock) pre-operative knee flexion (group A) and the inability to do so (group B). The overall clinical rating was "excellent" in 96% of patients and "good" in 4% of patients. Mean maximum knee flexion decreased from 137.9°to 134.8°, with no statistical difference between pre-and post-operative knee flexion. However, patients in group A had significantly decreased knee flexion (146.2°vs. 135.0°, p<0.001), whereas patients in group B exhibited no change in knee flexion (133.7°vs. 134.7°, p=0.14). We found that 14.7%, 36.5% and 43.0% of the studied patients could engage in kneeling, Thai polite style sitting and cross-legged sitting, respectively, with no significant differences between groups A and B. The survival rates for any reoperation and prosthesis-related problem (such as early loosening) at six years were 98.3% and 100%, respectively. At six-year follow-up in patients with well preserved pre-operative knee flexion, the highflexion knee prosthesis provided a favourable outcome without improving knee flexion.

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Section: Discussionmentioning

confidence: 57%

High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion: outcomes at six years of follow-up

Tanavalee

Ngarmukos

Tantavisut

et al. 2010

International Orthopaedics (SICOT)

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“…We observed a mean HSS score of 91 and a mean knee flexion of 133°. However, it cannot be determined by the present study and it remains unclear whether HF designs improve clinical ROM and function more than conventional implants [14,31,33].…”

Section: Discussionmentioning

confidence: 83%

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Lee

Chung²,

Kim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses.Questions/purposes We therefore determined (1) the rate of achieving postoperative HF after HF TKA; (2) whether the aseptic loosening rate of HF prostheses is high; and (3) whether the survivorship was worsened in patients who achieved postoperative deep knee flexion in our cohort of Korean patients. Methods We retrospectively reviewed 488 patients who had 698 primary TKAs using the NexGen 1 Legacy Posterior-Stabilized Flex system implanted from 2003 to 2010. There were 40 men and 448 women with a mean age of 68 years. We obtained Hospital for Special Surgery scores, maximal flexion, and radiographs. The minimum followup for functional and radiographic evaluations was 2 years (median, 4.8 years; range, 2-8.7 years). We performed a survival analysis on all patients for aseptic loosening. Results Three hundred sixty knees (52%) could achieve C 135°maximum flexion. Six of the 698 knees (0.9%) developed aseptic loosening (three femoral and three tibial). The survival at 5 years for aseptic loosening was 99.1%. The overall survival for aseptic failure did not differ between knees that achieved HF and those that did not.

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“…A recent metaanalysis by Gandhi et al concluded that HF implant designs improve the overall ROM compared with traditional implants but offer no clinical advantage in primary TKA [6]. In a systematic literature review focusing on outcomes after HF TKA, Murphy et al found that there was insufficient evidence to support the view that these new TKA designs improved ROM or functional performance [24]. This review included nine studies [1, 8,10,14,17,27,29,34,37] with 399 HF TKAs in 370 patients.…”

Section: Discussionmentioning

confidence: 97%

“…This review included nine studies [1, 8,10,14,17,27,29,34,37] with 399 HF TKAs in 370 patients. They conclude that the claims of greater flexion, ROM, and function for HF TKA reported in some of those studies were not supported due to poor study designs, short follow-up periods, inadequate blinding, and use of functional outcome measures that lacked sensitivity [24].…”

Section: Discussionmentioning

confidence: 99%

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

Malik

Salas²,

Ari

et al. 2009

International Orthopaedics (SICOT)

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It is debatable whether high-flexion (HF) total knee arthroplasty (TKA) designs will improve postoperative flexion and function or will diminish the need for manipulation under anaesthesia (MUA). We retrospectively analysed range of motion (ROM), flexion, Knee Society Score (KSS), and rate of MUA in a consecutive group of patients who underwent TKA with a conventional posterior stabilised (PS) insert or an HF insert using identical surgical technique, implant design, and postoperative care. Fifty TKAs with a standard PS insert were matched for patient's age, gender, preoperative ROM, and KSS with 50 TKA performed with an HF insert. The patient's ROM and KSS were evaluated at six weeks, four months, and one year postoperatively. The outcome variables (flexion, ROM, KSS, and manipulation rate) in both groups were compared using the generalised estimating equations method. A second analysis of patients with preoperative flexion ≥120°was performed. The ROM, flexion, and patient-reported KSS was similar in both groups at each time period. The rate of MUA was also similar. Patients with a preoperative ROM of at least 120°showed similar results. Our study found that one year after surgery, patients who underwent TKA with a PS or an HF insert achieved similar flexion, ROM, and function.

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High-flexion total knee arthroplasty: a systematic review

Cited by 61 publications

References 51 publications

High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion: outcomes at six years of follow-up

High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion: outcomes at six years of follow-up

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Range of motion and function are similar in patients undergoing TKA with posterior stabilised and high-flexion inserts

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