Abstract
BackgroundLittle information exists to support that patients care about flexion beyond what is needed to perform activities of daily living (ADL) after Total knee arthroplasty (TKA). The purpose of this study was to investigate if the achievement of a higher degree of knee flexion after TKA would result in a better patient perceived outcome.MethodsThe study is a randomized, double-blinded, controlled trial in which 36 patients (mean age: 67.2 yrs) undergoing one-stage bilateral TKA randomly received a standard cruciate-retaining (CR) TKA in one knee and a high-flex posterior-stabilized (PS) TKA in the contra lateral knee. At follow-up ROM, satisfaction, pain, “feel” of the knee and the abilities in daily activities were assessed.ResultsAt 1-year follow-up we found an expected significantly higher degree of knee flexion of 7° in the high-flex knees (p = 0.001). The high-flex TKA’s showed a mean active flexion of 121°. In both TKA’s the median VAS pain score was 0, the median VAS satisfaction score was 9, and the median VAS score of the patient “feel” of the knee was 9 at 1-year follow-up. Further, there were no significant differences between the knees in the performance of daily activities.ConclusionsAs expected the high-flex TKA showed increased knee flexion, but no significant differences in the patient perceived outcomes were found. This suggests little relevance to the patients of the difference in knee flexion – when flexion is of this magnitude – as pain free ROM and high patient satisfaction were achieved with both TKA’s.Trial registrationClinicalTrials.gov: NCT00294528
Highlights
Little information exists to support that patients care about flexion beyond what is needed to perform activities of daily living (ADL) after Total knee arthroplasty (TKA)
In this study we aimed to investigate whether patients care about the expected achievement of higher knee flexion after insertion of a high-flex PS TKA compared to a standard CR TKA, in terms of increased patient satisfaction, reduced pain, better “feel” of the knee and better abilities in activities of daily living
At 1year follow-up, of the CR TKA’s and of the high-flex PS TKA’s were able to extend to 0–5 degrees, no significant difference
Summary
Little information exists to support that patients care about flexion beyond what is needed to perform activities of daily living (ADL) after Total knee arthroplasty (TKA). The purpose of this study was to investigate if the achievement of a higher degree of knee flexion after TKA would result in a better patient perceived outcome. Restoration of knee flexion is an important factor in determining the functional outcome after total knee arthroplasty (TKA). Previous studies have shown that a minimum of 110 degrees of flexion is needed to complete activities of daily living such as walking normally, rising from a chair and ascending/descending stairs [10,11]. Studies show that increased flexion beyond 110 degrees leads to increased functional ability [10,12], and Ritter et al found that patients with ROM of 128 – 132 degrees achieved the best functional results [4]. Studies have not been able to show that increased flexion beyond 110 degrees have a significant influence on patient satisfaction
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