Maximal flexion and patient outcomes after TKA, using a bicruciate-stabilizing design
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KNEE ARTHROPLASTY
Maximal flexion and patient outcomes after TKA, using a bicruciate‑stabilizing design Nienke M. Kosse1 · Petra J. C. Heesterbeek1 · Koen C. Defoort2 · Ate B. Wymenga2 · Gijs G. van Hellemondt2 Received: 10 September 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Physiological motion after total knee arthroplasty (TKA) should result in a large range of motion, which would lead to good clinical outcomes. An adjusted design of a bicruciate-stabilizing TKA was developed to reproduce physiological motion. The aim of this study was to (1) investigate the maximal knee flexion of this knee system, 1 year post-operatively; (2) determine the clinical and functional improvement and compare the outcomes between patients with and without high maximal flexion; and (3) evaluate the adverse events. Materials and methods In this prospective study, 62 patients with osteoarthritis received a bicruciate-stabilizing TKA. Maximum flexion was measured on a lateral X-ray pre- and post-operatively. Clinical and functional scores and the adverse events were reported up until 2 years after surgery. Results Pre-operatively, the median (range) maximal flexion was 131.5 (90–153)° and 1 year post-operatively, it was 130 (82–150)°. The results for the clinical scores showed an improvement between pre-operative values and post-operative values. The Kujala score and Knee Osteoarthritis Outcome Score (KOOS) symptoms, sport and quality of life score were better in patients with high maximal flexion (≥ 125°). Ten (serious) adverse device events were reported. Conclusions In conclusion, the bicruciate-stabilizing TKA obtained a maximal flexion comparable to the flexion pre-operatively and resulted in good clinical and functional outcomes. Patients with high flexion ability seem to perform better on clinical and functional outcomes. Furthermore, the adjusted design of the bicruciate-stabilizing TKA reduced the number of adverse events. Level of evidence Prospective cohort study, Level II. Keywords Total knee arthroplasty · Maximal flexion · Clinical improvement · Functional improvement · Adverse events · Bicruciate-stabilized type
Introduction
Investigation performed at Sint Maartenskliniek, Nijmegen, The Netherlands. * Nienke M. Kosse [email protected] * Petra J. C. Heesterbeek [email protected] 1
Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM Nijmegen, The Netherlands
Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
2
An important factor in describing knee function after total knee arthroplasty (TKA) is the achieved maximal flexion. Sufficient range of knee flexion is required to perform activities of daily living [1]. It is expected that high flexion abilities will lead to high clinical and functional outcome scores and might consequently result in high patient satisfaction [2–4]. Post-operative, knee movement should reach a range of motion (≥ 125°) that is sufficient to perform activities of
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