A high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population

Hyuk-Soo Han,Myung Chul Lee,Sungho Won,Bora Lee,Jong Seop Kim

doi:10.1186/s12891-021-04369-4

Abstract

BackgroundThis study investigated whether achieving a higher degree of knee flexion after TKA promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life.MethodsClinical data on 912 consecutive primary TKA cases involving a single high-flexion posterior stabilized fixed-bearing prosthesis were retrospectively analyzed. Demographic and clinical data were collected, including knee flexion angle, the ability to perform high-flexion activities, and patient satisfaction and quality of life.ResultsOf the cases, 619 (68%) achieved > 130° of knee flexion after TKA (high flexion group). Knee flexion angle and clinical scores showed significant annual changes, with the maximum improvement seen at 5 years and slight deterioration observed at 10 years postoperatively. In the high flexion group, more than 50% of the patients could not kneel or squat, and 35% could not stand up from on the floor. Multivariate analysis revealed that > 130° of knee flexion, the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient satisfaction after TKA, while the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient quality of life after TKA.ConclusionsHigh knee flexion angle (> 130°) after TKA increased the ease of high-flexion activities and patient satisfaction. The ease of high-flexion activities also increased quality of life after TKA in our Asian patients, who frequently engage in these activities in daily life.

Highlights

This study investigated whether achieving a higher degree of knee flexion after total knee arthroplasty (TKA) promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life
Limited range of motion (ROM) is a significant cause of poor functional outcome and patient dissatisfaction, the associations among high degree of flexion, ability to perform high-flexion activities, and patient satisfaction after TKA are rarely studied [2, 9]
The most important findings of this study were that two-thirds (619/912, 67.9%) of Asian osteoarthritis patients could achieve high flexion (> 130°) after TKA, which would increase the ease of high-flexion activities and patient satisfaction

Summary

Introduction

This study investigated whether achieving a higher degree of knee flexion after TKA promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life. Restoration of knee flexion is an important determinant of the functional outcome after TKA. Failure to restore the ability to kneel and squat, and the importance of these movements to ADL, may contribute to lower satisfaction with TKA. High-flexion TKA is designed to achieve the > 130° of knee flexion necessary for ADL, including kneeling and gardening [8]. Limited ROM is a significant cause of poor functional outcome and patient dissatisfaction, the associations among high degree of flexion, ability to perform high-flexion activities, and patient satisfaction after TKA are rarely studied [2, 9]. The existing studies involved Western patients, who do not tend to use deep flexion frequently compared to Asian patients

Methods

Results

Conclusion