Measuring flexion in knee arthroplasty patients

This study is a systematic literature review of outcomes following total knee arthroplasty with implants specifically designed to enable increased knee flexion. English language comparative studies without date restriction were identified through a computerised literature search and bibliography review. Nine studies met the inclusion criteria representing a total of 399 high-flexion knee arthroplasties in 370 patients. Five studies reported greater flexion or range of motion; however, the methodological rigour was questionable with inadequate blinding, flawed participant selection, short follow-up periods and functional outcomes which lacked sensitivity. There was insufficient evidence of improved range of motion or functional performance after high-flexion knee arthroplasty.

Section: Discussionmentioning

confidence: 99%

High-flexion total knee arthroplasty: a systematic review

Murphy

Journeaux

Russell

2009

“…In some studies, bony landmarks are not used and the mid-line or long axis of the thigh and tibia are simply visualised for alignment [2]. Despite the simplicity and minimal cost, the accuracy of knee measurements obtained using a hand-held goniometer is dependent on the accurate alignment of the arms of the device between bony landmarks, which are often visualised rather than marked [8]. Palpation of bony landmarks around the hip and knee regions can prove difficult in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…Range of knee joint motion is generally assessed either visually or with a hand-held goniometer. Plain radiographs have been used to measure preoperative and postoperative knee flexion in research studies [8], whilst computer-assisted navigation has been recently used to analyse range of knee motion during surgery [1]. Employing the same technique to measure range of motion between different time-points rather than a variety of techniques has been advised [8].…”

Section: Introductionmentioning

confidence: 99%

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Measurement of knee joint motion using digital imaging

Bennett

Hanratty

Thompson

et al. 2008

The measurement of joint motion is common practice in many aspects of orthopaedic surgery. A number of techniques and instruments have been developed for this purpose. We describe a method of recording and measuring knee joint motion using digital imaging which demonstrated high inter-observer reliability (r>0.948) and intra-observer repeatability (r>0.906). This technique may offer some practical advantages over other methods of measuring joint motion.Résumé La mesure de la mobilité articulaire est une pratique habituelle en chirurgie orthopédique. De nombreux instruments peuvent être développés. Nous décrivons une méthode de la mesure de la mobilité en utilisant une imagerie digitalisée. Ces techniques montrent une importante sensibilité inter-observateur (r>0,948) et intra observateur avec une bonne répétabilité (r>0,906). En conclusion, cette technique est fiable, répétitive et suffisamment sure offrant un certain nombre d'avantages pratiques.

“…In daily activities, active knee flexion is more important than passive knee flexion, but passive ROM is usually reported and measured using a hand-held goniometer or as a visual estimation of knee flexion. Edwards et al [23] reported 22 % of skin surface goniometric measurements and 45 % of visual measurements differed by 5°or greater from radiographic measurements. Laidlaw et al [24] showed postoperative active knee flexion is less than postoperative passive knee flexion using the active flexion lateral radiograph, and suggested active knee flexion may be an important outcome variable for assessing functional results after TKA.…”

Section: Discussionmentioning

confidence: 99%

Influence of intra-operative parameters on postoperative early recovery of active knee flexion in posterior-stabilized total knee arthroplasty

Nagai¹,

Muratsu²,

Matsumoto

et al. 2013

Purpose Active knee flexion is more important for daily activities than passive knee flexion. The hypothesis is that the intra-operative parameters such as osteotomized bone thickness and soft tissue balance affect the postoperative active flexion angle in total knee arthroplasty (TKA). Therefore, we evaluate the influence of intra-operative parameters on postoperative early recovery of active flexion after posteriorstabilized (PS) TKA. Methods The subjects were 45 osteoarthritic knees undergoing primary PS TKA with anterior-reference technique. Intraoperative soft tissue balance was measured using an offset type tensor, and each osteotomized bone thickness was also measured. Pre-and postoperative active knee flexion angles were measured using lateral radiographs. Liner regression analysis was used to determine the influence of these intraoperative parameters on postoperative active flexion angles or recovery of active flexion angles. Results Pre-operative flexion angle was positively correlated with postoperative flexion angle (R=0.52, P=0.0002). Postoperative flexion angle was negatively correlated with the osteotomized bone thickness of femoral medial posterior condyle (R=−0.37, P=0.012), and femoral lateral posterior condyle (R=−0.36, P=0.015). Recovery of flexion angle was slightly negatively correlated with gap difference calculated by subtracting joint gap at extension from that at flexion between osteotomized surfaces (R=−0.30, P=0.046). ConclusionsThe osteotomized bone thickness of the femoral posterior condyle is a significant independent factor of postoperative flexion angles. This indicates that the restoration of the posterior condyle offset may lead to larger postoperative active flexion angles in PS TKA.