Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without: ten-year prospective data

Abstract

Range of motion (ROM) is an important outcome variable after total knee arthroplasty (TKA). This may be compounded by a pre-existing fixed flexion deformity (FFD). We therefore examined the long-term outcomes of patients with a flexion deformity undergoing TKA compared to those without a preoperative fixed flexion deformity. Participants who had undergone TKA at our centre between 1989 and 2002 were examined preoperatively, one, five and ten years after TKA (Kinemax PS; Howmedica, Rutherford, NJ, USA). Examining those with a preoperative FFD of greater than ten degrees with complete ten year follow-up data revealed 77 individuals. Seventy seven age, sex and body mass index matched patients were identified and the effect of TKA on indices of knee function (fixed flexion, maximum flexion, total ROM and Knee Society score (KSS) in both groups were analysed using repeated measures ANOVA. A significant difference between the groups with respect to fixed flexion (p<0.001), total ROM (p=0.001) and KSS (p<0.001) was observed between baseline and year one suggesting that those with a preoperative FFD improved more than those without. A significant difference with regard to fixed flexion was also observed between years one to five (p=0.001) and just failed to reach statistical significance between five to ten years (p=0.052) between the groups. This study demonstrates that patients with a preoperative fixed flexion deformity show continued improvement in their fixed flexion up to ten years post arthroplasty and have similar outcomes to those with no preoperative fixed flexion.

Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis

“…Nexgen LPS-Flex 35 (35) 104 (17) 106 (14) N/S N/S Nutton et al [13] 2008 Scotland In the selected papers, the method of measurement of ROM was generally unclear and lacked uniformity. Ten of the studies indicated their means of measurement using a universal goniometer [12-14, 16, 26-28, 30, 34, 35, 38] and only six reported basic technical details [13,14,16,26,28,33]. There were only four studies that reported a randomised controlled trial (RCT) comparing H-F PS and conventional PS TKAs [11,13,15,20].…”

“…Among them, four dealt with the comparison of PS TKA and cruciate retaining (CR) TKA [30,31,33,35]; two were the comparison of PS TKA with PS mobile-bearing TKA [27,36]; one was the comparison of PS TKA to H-F PS mobile-bearing TKA [32]; and one was the comparison of PS TKA with H-F PS TKA [13]. Six of the 18 selected studies were case controlled studies that included the H-F PS TKAs [12,14,16,28,29,37]. Among these, four dealt with comparison of standard PS TKA to H-F PS TKA [12,14,16,29]; one study was on the comparison of flexion contracture patients to the no-flexion contracture patients [28] and one study was on the comparison of MIS PS TKA to conventional TKA [37].…”

“…Six of the 18 selected studies were case controlled studies that included the H-F PS TKAs [12,14,16,28,29,37]. Among these, four dealt with comparison of standard PS TKA to H-F PS TKA [12,14,16,29]; one study was on the comparison of flexion contracture patients to the no-flexion contracture patients [28] and one study was on the comparison of MIS PS TKA to conventional TKA [37].…”

Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomised controlled trial

“…This may be explained by the fact that the fixed-bearing group had a statistically significantly greater preoperative mean flexion deformity. It has recently been shown by Cheng et al [25] that subjects with a pre-existing fixed flexion deformity had a statistically significantly greater improvement in extension than subjects without, due to operative correction of the deformity.…”

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

“…While some studies have reported that the condition does not improve postoperatively [17][18][19][20], other investigators have shown gradual recovery with conservative management [19,[21][22][23][24]. It has been well established that the presence of a preoperative flexion contracture increases the risk of developing a postoperative flexion contracture [5].…”