The Mid-Term Results of High-Flex Total Knee Arthroplasty: Minimum 5-Year Follow-Up Results

Kwang Mee Kim; Churl Hong Chun; Hong Je Kang; Sung Hyun No

doi:10.4055/jkoa.2012.47.4.271

Journal List > J Korean Orthop Assoc > v.47(4) > 1013162

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Chun, Kang, and No: The Mid-Term Results of High-Flex Total Knee Arthroplasty: Minimum 5-Year Follow-Up Results

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(4): 271-276.

Published online: 27 August 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.4.271

The Mid-Term Results of High-Flex Total Knee Arthroplasty: Minimum 5-Year Follow-Up Results

Kwang Mee Kim, Ph.D.^*, Churl Hong Chun, M.D., Hong Je Kang, M.D., Sung Hyun No, M.D.

Department of Orthopedic Surgery, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Iksan, Korea.

^*Department of Nursing School, Chodang University, Muan, Korea.

Correspondence to: Churl Hong Chun, M.D. Department of Orthopedic Surgery, Wonkwang University College of Medicine, 895, Muwang-ro, Iksan 570-711, Korea. TEL: +82-63-859-1360, FAX: +82-63-852-9329, cch@wonkwang.ac.kr

Received 9 December 2011 Revised 9 January 2012 Accepted 1 February 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the mid-term results of high-flexion total knee arthroplasty.

Materials and Methods

We retrospectively reviewed 77 patients who underwent 119 total knee arthroplastys using high-flexion implants (LPS-flex® , Zimmer, Warsaw, IN, USA) from November 2004 to June 2006. The mean age was 67.3 years (range, 54-83 years), and the average follow-up duration was 71.1 months. We assessed preoperative and last follow-up functional outcomes with ranges of motion (ROM) and the Hospital for Special Surgery (HSS) score and investigated their ability to squat, sit cross-legged knee, kneel, or stand up from the floor or a chair at the final follow-up. The Knee Society Radiographic evaluation and scoring system was used for radiologic evaluation.

Results

The mean ROM increased from 104.7° preoperatively to 129.8° postoperatively at the final follow-up. The average HSS score improved from 42.7 points preoperatively to 93.5 points postoperatively. At the final follow-up, 33 patients (42.8%) were able to squat; 75 patients (97.4%) were able to sit cross-legged; 27 patients (35.0%) were able to kneel; 45 patients (58.4%) were able to stand up from the floor and 73 patients (94.8%) were able to stand up from a chair. Six cases encountered stiff knees as a complications, and were treated with manipulation procedures. 1 mm radiolucent lines were detected in 5 cases, but none of them were progressive.

Conclusion

We believe that the hyperflexion implant itself is not a cause of early loosening. Research on reasons regarding early loosening and long-term follow-ups will be needed.

Keywords: total knee arthroplasty, high-flexion implants

Figures and Tables

Figure 1

A 68-year-old female with left knee osteoarthritis underwent total knee arthroplasty using high flexion prosthesis. (A) She could sit cross-legged, kneel and squat comfortably at 68 months follow-up. (B, C) Anteroposterior, lateral, and fluoroscopic views showed no loosening or wear. (D) Lateral full flexion view was obtained to measure further flexion angle.

Table 1

Clinical and Radiological Results

The values are presented as mean±standard deviation. HSS, Hospital for Special Surgery; OP, operation.

Table 2

Functional Results at the Final Follow-Up

References

1. Bin SI, Nam TS. Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc. 2007. 15:350–355.

2. Jung KH, Cho SD, Ko SH, et al. Early results of primary high flex total knee arthroplasty. J Korean Knee Soc. 2005. 17:234–240.

3. Kim TH, Lee DH, Bin SI. The NexGen LPS-flex to the knee prosthesis at a minimum of three years. J Bone Joint Surg Br. 2008. 90:1304–1310.

4. Lee BS, Kim JM, Lee SJ, et al. High-flexion total knee arthro-plasty improves flexion of stiff knees. Knee Surg Sports Traumatol Arthrosc. 2011. 19:936–942.

5. Yoon YS, Rah JH, Oh JR, Park HK, Ryu HY. Three years follow-up results of high-flex total knee arthroplasty. J Korean Knee Soc. 2007. 19:231–236.

6. Kim YH, Sohn KS, Kim JS. Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am. 2005. 87:1470–1475.

7. Nutton RW, van der Linden ML, Rowe PJ, Gaston P, Wade FA. A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components. J Bone Joint Surg Br. 2008. 90:37–42.

8. Cho SD, Ko SH, Park MS, et al. Early loosening of femoral component after primary total knee arthroplasty: report of 4 cases. J Korean Knee Soc. 2006. 18:107–111.

9. Cho SD, Youm YS, Park KB. Three- to six-year follow-up results after high-flexion total knee arthroplasty: can we allow passive deep knee bending? Knee Surg Sports Traumatol Arthrosc. 2011. 19:899–903.

10. Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. J Bone Joint Surg Br. 2007. 89:1457–1461.

11. Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ. Measuring flexion in knee arthroplasty patients. J Arthroplasty. 2004. 19:369–372.

12. Song YJ, Ha CW. A comparison of the functional results of high-flex total knee arthroplasty: LPS-Flex vs. Scorpio-Flex TKA. J Korean Orthop Assoc. 2009. 44:180–185.

13. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989. 248:9–12.

14. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br. 2002. 84:50–53.

15. Kim KM, Chun CH, Im JC. The results of the P.F.C.(R) sigma(TM) RP-F knee system in high flex rotating platform total knee arthroplasty -comparison of preoperative range of motion less than 90degrees versus more than 90degrees-. J Korean Knee Soc. 2010. 22:255–261.

16. Lizaur A, Marco L, Cebrian R. Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis. J Bone Joint Surg Br. 1997. 79:626–629.

17. Matsuda Y, Ishii Y, Noguchi H, Ishii R. Varus-valgus balance and range of movement after total knee arthroplasty. J Bone Joint Surg Br. 2005. 87:804–808.

18. Schurman DJ, Parker JN, Ornstein D. Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty. J Bone Joint Surg Am. 1985. 67:1006–1014.

TOOLS

Similar articles