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Clinical outcome of posterior-stabilized total knee arthroplasty using an increased flexion gap in patients with preoperative stiffness.
Bone Joint J. 2020 Apr; 102-B(4):426-433.BJ

Abstract

AIMS

To compare patients undergoing total knee arthroplasty (TKA) with ≤ 80° range of movement (ROM) operated with a 2 mm increase in the flexion gap with matched non-stiff patients with at least 100° of preoperative ROM and balanced flexion and extension gaps.

METHODS

In a retrospective cohort study, 98 TKAs (91 patients) with a preoperative ROM of ≤ 80° were examined. Mean follow-up time was 53 months (24 to 112). All TKAs in stiff knees were performed with a 2 mm increased flexion gap. Data were compared to a matched control group of 98 TKAs (86 patients) with a mean follow-up of 43 months (24 to 89). Knees in the control group had a preoperative ROM of at least 100° and balanced flexion and extension gaps. In all stiff and non-stiff knees posterior stabilized (PS) TKAs with patellar resurfacing in combination with adequate soft tissue balancing were used.

RESULTS

Overall mean ROM in stiff knees increased preoperatively from 67° (0° to 80°) to 114° postoperatively (65° to 135°) (p < 0.001). Mean knee flexion improved from 82° (0° to 110°) to 115° (65° to 135°) and mean flexion contracture decreased from 14° (0° to 50°) to 1° (0° to 10°) (p < 0.001). The mean Knee Society Score (KSS) improved from 34 (0 to 71) to 88 (38 to 100) (p < 0.001) and the KSS Functional Score from 43 (0 to 70) to 86 (0 to 100). Seven knees (7%) required manipulations under anaesthesia (MUA) and none of the knees had flexion instability. The mean overall ROM in the control group improved from 117° (100° to 140°) to 123° (100° to 130°) (p < 0.001). Mean knee flexion improved from 119° (100° to 140°) to 123° (100° to 130°) (p < 0.001) and mean flexion contracture decreased from 2° (0° to 15°) to 0° (0° to 5°) (p < 0.001). None of the knees in the control group had flexion instability or required MUA. The mean KSS Knee Score improved from 48 (0 to 80) to 94 (79 to 100) (p < 0.001) and the KSS Functional Score from 52 (5 to 100) to 95 (60 to 100) (p < 0.001). Mean improvement in ROM (p < 0.001) and KSS Knee Score (p = 0.017) were greater in knees with preoperative stiffness compared with the control group, but the KSS Functional Score improvement was comparable (p = 0.885).

CONCLUSION

TKA with a 2 mm increased flexion gap provided a significant improvement of ROM in knees with preoperative stiffness. While the improvement in ROM was greater, the absolute postoperative ROM was less than in matched non-stiff knees. PS TKA with patellar resurfacing and a 2 mm increased flexion gap, in combination with adequate soft tissue balancing, provides excellent ROM and knee function when stiffness of the knee had been present preoperatively. Cite this article: Bone Joint J 2020;102-B(4):426-433.

Authors+Show Affiliations

Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York, USA.Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York, USA.Department of Orthopedic Surgery, University of Ulm, Ulm, Germany.Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany.Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32228087

Citation

Boettner, Friedrich, et al. "Clinical Outcome of Posterior-stabilized Total Knee Arthroplasty Using an Increased Flexion Gap in Patients With Preoperative Stiffness." The Bone & Joint Journal, vol. 102-B, no. 4, 2020, pp. 426-433.
Boettner F, Sculco P, Faschingbauer M, et al. Clinical outcome of posterior-stabilized total knee arthroplasty using an increased flexion gap in patients with preoperative stiffness. Bone Joint J. 2020;102-B(4):426-433.
Boettner, F., Sculco, P., Faschingbauer, M., Rueckl, K., Windhager, R., & Kasparek, M. F. (2020). Clinical outcome of posterior-stabilized total knee arthroplasty using an increased flexion gap in patients with preoperative stiffness. The Bone & Joint Journal, 102-B(4), 426-433. https://doi.org/10.1302/0301-620X.102B4.BJJ-2018-1404.R3
Boettner F, et al. Clinical Outcome of Posterior-stabilized Total Knee Arthroplasty Using an Increased Flexion Gap in Patients With Preoperative Stiffness. Bone Joint J. 2020;102-B(4):426-433. PubMed PMID: 32228087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcome of posterior-stabilized total knee arthroplasty using an increased flexion gap in patients with preoperative stiffness. AU - Boettner,Friedrich, AU - Sculco,Peter, AU - Faschingbauer,Martin, AU - Rueckl,Kilian, AU - Windhager,Reinhard, AU - Kasparek,Maximilian F, PY - 2020/4/2/entrez PY - 2020/4/2/pubmed PY - 2020/4/14/medline KW - Flexion gap KW - Posterior-stabilized knee arthroplasty KW - Preoperative stiffness KW - Range of motion KW - Total knee arthroplasty SP - 426 EP - 433 JF - The bone & joint journal JO - Bone Joint J VL - 102-B IS - 4 N2 - AIMS: To compare patients undergoing total knee arthroplasty (TKA) with ≤ 80° range of movement (ROM) operated with a 2 mm increase in the flexion gap with matched non-stiff patients with at least 100° of preoperative ROM and balanced flexion and extension gaps. METHODS: In a retrospective cohort study, 98 TKAs (91 patients) with a preoperative ROM of ≤ 80° were examined. Mean follow-up time was 53 months (24 to 112). All TKAs in stiff knees were performed with a 2 mm increased flexion gap. Data were compared to a matched control group of 98 TKAs (86 patients) with a mean follow-up of 43 months (24 to 89). Knees in the control group had a preoperative ROM of at least 100° and balanced flexion and extension gaps. In all stiff and non-stiff knees posterior stabilized (PS) TKAs with patellar resurfacing in combination with adequate soft tissue balancing were used. RESULTS: Overall mean ROM in stiff knees increased preoperatively from 67° (0° to 80°) to 114° postoperatively (65° to 135°) (p < 0.001). Mean knee flexion improved from 82° (0° to 110°) to 115° (65° to 135°) and mean flexion contracture decreased from 14° (0° to 50°) to 1° (0° to 10°) (p < 0.001). The mean Knee Society Score (KSS) improved from 34 (0 to 71) to 88 (38 to 100) (p < 0.001) and the KSS Functional Score from 43 (0 to 70) to 86 (0 to 100). Seven knees (7%) required manipulations under anaesthesia (MUA) and none of the knees had flexion instability. The mean overall ROM in the control group improved from 117° (100° to 140°) to 123° (100° to 130°) (p < 0.001). Mean knee flexion improved from 119° (100° to 140°) to 123° (100° to 130°) (p < 0.001) and mean flexion contracture decreased from 2° (0° to 15°) to 0° (0° to 5°) (p < 0.001). None of the knees in the control group had flexion instability or required MUA. The mean KSS Knee Score improved from 48 (0 to 80) to 94 (79 to 100) (p < 0.001) and the KSS Functional Score from 52 (5 to 100) to 95 (60 to 100) (p < 0.001). Mean improvement in ROM (p < 0.001) and KSS Knee Score (p = 0.017) were greater in knees with preoperative stiffness compared with the control group, but the KSS Functional Score improvement was comparable (p = 0.885). CONCLUSION: TKA with a 2 mm increased flexion gap provided a significant improvement of ROM in knees with preoperative stiffness. While the improvement in ROM was greater, the absolute postoperative ROM was less than in matched non-stiff knees. PS TKA with patellar resurfacing and a 2 mm increased flexion gap, in combination with adequate soft tissue balancing, provides excellent ROM and knee function when stiffness of the knee had been present preoperatively. Cite this article: Bone Joint J 2020;102-B(4):426-433. SN - 2049-4408 UR - https://www.unboundmedicine.com/medline/citation/32228087/Clinical_outcome_of_posterior_stabilized_total_knee_arthroplasty_using_an_increased_flexion_gap_in_patients_with_preoperative_stiffness_ L2 - https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.102B4.BJJ-2018-1404.R3?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -