DOI: http://dx.doi.org/10.18203/2349-2902.isj20200304

Increasing range of motion in total knee replacement using novel patellar resection technique

Ashok Suryavanshi

Abstract


Background: Total knee arthroplasty (TKA) is a surgical procedure designed to alleviate pain and improve function in patients suffering from osteoarthritis. Range of motion is one of the most important factors for patient satisfaction after total knee replacement. The purpose of this study was to assess the effectiveness of a new TKA technique involving patellar resection to enable increased flexion of the knee joint.

Methods: Eighty-four patients suffering from osteoarthritis with an indication for conducting TKA underwent the novel procedure. Pre-operative and post-operative flexion measurements were assessed.

Results: Mean age of patients participating in this study was 62 years. Males and females were 63% and 37 % of total population respectively. The mean pre-operative and post-operative flexion measurements were 97.39±3.33 º and 131.35±4.27 respectively. The mean in flexion measurements was improved by 33.95±5.30 º (p<0.05). The joint was kinematically stable during full flexion, mid-flexion, and extension.

Conclusions: The novel patellar resection technique can be beneficial for the patients. They can able to follow their native lifestyle and perform their daily activities without any hindrance. The mean increase in the range of flexion was 33.95±5.30 º (ranged 30-35 º, p<0.05). This technique allowed patients to have a greater range of flexion as compared to standard and high flexion designs.


Keywords


TKA, Osteoarthritis, Range of motion, Flexion, Patellar resection, Pressed fit condylar

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References


Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Casp J Intern Med. 2011;2:205-12.

Abbott JH, Usiskin IM, Wilson R, Hansen P, Losina E. The quality-of-life burden of knee osteoarthritis in New Zealand adults: A model-based evaluation. PLoS One. 2017;12(10):e0185676.

Meier W, Mizner RL, Marcus RL, Dibble LE, Peters C, Lastayo PC. Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther. 2008;38:246-56.

Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Therap. 2010;40:559-67.

Lingard EA, Katz JN, Wright EA, Sledge CB. Kinemax Outcomes Group. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004;86:2179-86.

The Asian Knee through a cultural lens. Available at: https://aorecon.aofoundation.org/news/51.html. Accessed on 24 July 2019.

McCalden RW, MacDonald SJ, Bourne RB, Marr JT. A randomized controlled trial comparing “high-flex” vs “standard” posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty. J Arthroplast. 2009;24:33-8.

Sharma A, Komistek RD, Scuderi GR, Cates HE. High-flexion TKA designs: what are their in vivo contact mechanics?. Clin Orthop. 2007;464:117-26.

Han H-S, Kang S-B. Brief followup report: does high-flexion total knee arthroplasty allow deep flexion safely in Asian patients?. Clin Orthop Related Res. 2013;471:1492-7.

Mai KT, Verioti CA, Hardwick ME, Ezzet KA, Copp SN, Colwell CW. Measured flexion following total knee arthroplasty. Orthopedics. 2012:35:e1472-5.

Guild GN, Labib SA. Range of motion in high flexion total knee arthroplasty vs. standard posterior stabilized total knee arthroplasty a prospective randomized study. Joint Implant Surg Res Foundation. 2013;3:22-8.

Ohno H, Murata M, Ozu S, Matsuoka N, Kawamura H, Lida H. Midterm outcomes of high-flexion total knee arthroplasty on japanese lifestyle. Acta Orthop Traumatol Turc. 2016;50:527-32.

Abolghasemian M, Samiezadeh S, Sternheim A, Bougherara H, Barnes CL, Backstein DJ. Effect of patellar thickness on knee flexion in total knee arthroplasty: a biomechanical and experimental study. J Arthroplast. 2014;29:80-4.

Bengs BC, Scott RD. The effect of patellar thickness on intraoperative knee flexion and patellar tracking in total knee arthroplasty. J Arthroplast. 2006;21:650-5.

Mutsuzaki H, Takeuchi R, Mataki Y, Wadano Y. Target range of motion for rehabilitation after total knee arthroplasty. J Rural Med. 2017;12:33-7.

Anouchi YS, McShane M, Kelly F, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthop. 1996;331:87-92.

Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KD. Range of motion after total knee arthroplasty. The effect of implant design and weight-bearing conditions. J Arthroplast. 1998: 13;748-52.

Wang Z, Wei M, Zhang Q, Zhang Z, Cui Y. Comparison of high-flexion and conventional implants in total knee arthroplasty: a meta-analysis. Med Sci Monitor: Intl Med J Exp Clin Res. 2015;21:1679-86.

Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses. J Bone Joint Surg. 2005;87-A:1470-5.

Ng FY, Wong HL, Yau WP, Chiu KY, Tang WM. Comparison of range of motion after standard and high-flexion posterior stabilised total knee replacement. Intl Orthop. 2008;32:795-8.

Tanavalee A, Ngarmukos S, Tantavisut S, Limtrakul A. High-flexion TKA in patients with a minimum of 120 º of pre-operative knee flexion: outcomes at six years of follow-up. Intl Orthop. 2011;35:1321-6.

Jain S, Pathak AC, Kanniyan K, Kulkarni S, Tawar S, Mane P. High-flexion posterior-stabilized total knee prosthesis: is it worth the hype?. Knee Surg Related Res. 2013;25:100-5.

Jain A. A comparative analysis of the clinical and functional outcomes of high flexion and standard total knee replacement prosthesis. Available at: http://www.mch-orth.com/pdf/Dr.%20ANUBHAV %20JAIN.pdf. Accessed on 29 July 2019.