A high-flexion design total knee prosthesis: a ten to twelve-year follow-up study.
Clinical outcomes
High flexion
Loosening
Range of motion
Total knee arthroplasty
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
28 Sep 2024
28 Sep 2024
Historique:
received:
20
08
2024
accepted:
13
09
2024
medline:
29
9
2024
pubmed:
29
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
The purpose of this study was to investigate the clinical and radiographic outcomes and to determine the survivorship of a high-flexion design total knee arthroplasty (TKA) prosthesis, the LOSPA knee system, over a follow-up period of 10-12 years. The study included 386 patients (503 TKAs) who were treated with TKA from 2011 to 2013 (follow-up period 10-12 years).The patients were assessed clinically using range of motion (ROM) of the knee, the Knee Society scoring system (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For radiographic analysis, the positions of femoral and tibial implants as α, β, γ, and δ angles, hip knee ankle (HKA) angle, and radiolucent lines were used. Kaplan-Meier survival analysis was performed. Mean ROM improved significantly from the preoperative baseline of 117.3° to 126.5° at the final follow-up (p < 0.001). The mean KSS and WOMAC scores also both showed significant improvement after surgery (all p < 0.001). A non-progressive radiolucent line less than 2 mm was observed in 23 cases (4.7%). Nine patients underwent revision surgery on the knee during the follow-up period. Revision surgery was performed on four patients due to aseptic loosening, three patients due to infection, one patient due to ankylosis, and one patient due to instability. When the endpoint of survival was the entire surgical cases, the survival rate was 96.2%. The survival rate, with revision for any reason as the endpoint, was 97.2%, and 97.8% for aseptic causes. The LOSPA knee system, a high-flexion design total knee prosthesis, showed excellent long-term survivorship and improvements in clinical outcomes at 10- to 12-year follow-up.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study was to investigate the clinical and radiographic outcomes and to determine the survivorship of a high-flexion design total knee arthroplasty (TKA) prosthesis, the LOSPA knee system, over a follow-up period of 10-12 years.
METHODS
METHODS
The study included 386 patients (503 TKAs) who were treated with TKA from 2011 to 2013 (follow-up period 10-12 years).The patients were assessed clinically using range of motion (ROM) of the knee, the Knee Society scoring system (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For radiographic analysis, the positions of femoral and tibial implants as α, β, γ, and δ angles, hip knee ankle (HKA) angle, and radiolucent lines were used. Kaplan-Meier survival analysis was performed.
RESULTS
RESULTS
Mean ROM improved significantly from the preoperative baseline of 117.3° to 126.5° at the final follow-up (p < 0.001). The mean KSS and WOMAC scores also both showed significant improvement after surgery (all p < 0.001). A non-progressive radiolucent line less than 2 mm was observed in 23 cases (4.7%). Nine patients underwent revision surgery on the knee during the follow-up period. Revision surgery was performed on four patients due to aseptic loosening, three patients due to infection, one patient due to ankylosis, and one patient due to instability. When the endpoint of survival was the entire surgical cases, the survival rate was 96.2%. The survival rate, with revision for any reason as the endpoint, was 97.2%, and 97.8% for aseptic causes.
CONCLUSIONS
CONCLUSIONS
The LOSPA knee system, a high-flexion design total knee prosthesis, showed excellent long-term survivorship and improvements in clinical outcomes at 10- to 12-year follow-up.
Identifiants
pubmed: 39342376
doi: 10.1186/s13018-024-05082-3
pii: 10.1186/s13018-024-05082-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
599Informations de copyright
© 2024. The Author(s).
Références
Kamei G, Ishibashi S, Yoshioka K, Sakurai S, Inoue H, Mochizuki Y, et al. Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty. Knee Surg Relat Res. 2022;34:10.
pubmed: 35272708
pmcid: 8908638
doi: 10.1186/s43019-022-00142-6
Kim DH, Jeong SY, Yang JH, Choi CH. Evaluation of appropriateness of the Reimbursement Criteria of Korean Health Insurance Review and Assessment Service for Total Knee Arthroplasty. Clin Orthop Surg. 2023;15:241–8.
pubmed: 37008978
doi: 10.4055/cios21214
Ko K, Kim KH, Ko S, Jo C, Han HS, Lee MC, Ro DH. Total knee arthroplasty: is it safe? A single-center study of 4,124 patients in South Korea. Clin Orthop Surg. 2023;15:935–41.
pubmed: 38045584
doi: 10.4055/cios22088
Sarac DC, Unver B, Karatosun V. Validity and reliability of performance tests as balance measures in patients with total knee arthroplasty. Knee Surg Relat Res. 2022;34:11.
pubmed: 35272697
pmcid: 8908580
doi: 10.1186/s43019-022-00136-4
Simcox T, Singh V, Oakley CT, Barzideh OS, Schwarzkopf R, Rozell JC. A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty. Knee Surg Relat Res. 2022;34:14.
pubmed: 35303957
pmcid: 8932132
doi: 10.1186/s43019-022-00143-5
Wong SYW, Ler FLS, Sultana R, Bin Abd Razak HR. What is the best prophylaxis against venous thromboembolism in asians following total knee arthroplasty? A systematic review and network meta-analysis. Knee Surg Relat Res. 2022;34:37.
pubmed: 35964142
pmcid: 9375282
doi: 10.1186/s43019-022-00166-y
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468:57–63.
pubmed: 19844772
doi: 10.1007/s11999-009-1119-9
Devers BN, Conditt MA, Jamieson ML, Driscoll MD, Noble PC, Parsley BS. Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty? J Arthroplasty. 2011;26:178–86.
pubmed: 20413247
doi: 10.1016/j.arth.2010.02.008
Huddleston JI, Scarborough DM, Goldvasser D, Freiberg AA, Malchau H. 2009 Marshall Urist Young Investigator Award: how often do patients with high-flex total knee arthroplasty use high flexion? Clin Orthop Relat Res. 2009;467:1898 – 906.
Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T. Maximizing flexion after total knee arthroplasty: the need and the pitfalls. J Arthroplasty. 2002;17:59–62.
pubmed: 12068407
doi: 10.1054/arth.2002.32688
Kim MS, Koh IJ, Jang SW, Jeon NH, In Y. Two- to four-year follow-up results of total knee arthroplasty using a New High-Flexion Prosthesis. Knee Surg Relat Res. 2016;28:39–45.
pubmed: 26955612
pmcid: 4779804
doi: 10.5792/ksrr.2016.28.1.39
Kim MS, Kim JH, Koh IJ, Jang SW, Jeong DH. Is high-flexion total knee arthroplasty a valid Concept? Bilateral Comparison with Standard Total Knee Arthroplasty. J Arthroplasty. 2016;31:802–8.
pubmed: 26411392
doi: 10.1016/j.arth.2015.09.001
Dennis DA, Heekin RD, Clark CR, Murphy JA, O’Dell TL, Dwyer KA. Effect of implant design on knee flexion. J Arthroplasty. 2013;28:429–38.
pubmed: 23219622
doi: 10.1016/j.arth.2012.07.019
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;87:1470–5.
pubmed: 15995113
Angerame MR, Eschen CL, Johnson RM, Jennings JM, Dennis DA. Ten-year Follow-Up of high-flexion Versus Conventional total knee arthroplasty: a matched-control study. J Arthroplasty. 2021;36:2795–800.
pubmed: 33810919
doi: 10.1016/j.arth.2021.03.017
Barink M, De Waal Malefijt M, Celada P, Vena P, Van Kampen A, Verdonschot N. A mechanical comparison of high-flexion and conventional total knee arthroplasty. Proc Inst Mech Eng H. 2008;222:297–307.
pubmed: 18491699
doi: 10.1243/09544119JEIM353
Bollars P, Luyckx JP, Innocenti B, Labey L, Victor J, Bellemans J. Femoral component loosening in high-flexion total knee replacement: an in vitro comparison of high-flexion versus conventional designs. J Bone Joint Surg Br. 2011;93:1355–61.
pubmed: 21969434
doi: 10.1302/0301-620X.93B10.25436
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;89:1457–61.
pubmed: 17998181
doi: 10.1302/0301-620X.89B11.19840
Jung WH, Jeong JH, Ha YC, Lee YK, Koo KH. High early failure rate of the Columbus posterior stabilized high-flexion knee prosthesis. Clin Orthop Relat Res. 2012;470:1472–81.
pubmed: 22120476
doi: 10.1007/s11999-011-2202-6
Bauman RD, Johnson DR, Menge TJ, Kim RH, Dennis DA. Can a high-flexion total knee arthroplasty relieve pain and restore function without premature failure? Clin Orthop Relat Res. 2012;470:150–8.
pubmed: 22006196
doi: 10.1007/s11999-011-2099-0
Kim YH, Park JW, Kim JS. Do high-flexion total knee designs increase the risk of femoral component loosening? J Arthroplasty. 2017;32:1862–8.
pubmed: 28238582
doi: 10.1016/j.arth.2017.01.026
Lee BS, Chung JW, Kim JM, Kim KA, Bin SI. High-flexion prosthesis improves function of TKA in Asian patients without decreasing early survivorship. Clin Orthop Relat Res. 2013;471:1504–11.
pubmed: 23104044
doi: 10.1007/s11999-012-2661-4
Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of Osteoarthritis. Clin Orthop Relat Res. 2016;474:1886–93.
pubmed: 26872913
pmcid: 4925407
doi: 10.1007/s11999-016-4732-4
Koh IJ, Kwak DS, Kim TK, Park IJ, In Y. How effective is multiple needle puncturing for medial soft tissue balancing during total knee arthroplasty? A cadaveric study. J Arthroplasty. 2014;29:2478–83.
pubmed: 24360488
doi: 10.1016/j.arth.2013.11.004
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–40.
pubmed: 3068365
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989:13–4.
Lee CR, Park DH, Heo KS, Jo SM, Seo KJ, Seo SS. Long-term outcomes of high-Flexion Design total knee arthroplasty with a short posterior flange. Clin Orthop Surg. 2024;16:251–8.
pubmed: 38562641
pmcid: 10973616
doi: 10.4055/cios23133
Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989:9–12.
Gonzalez MH, Mekhail AO. The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg. 2004;12:436–46.
pubmed: 15615509
doi: 10.5435/00124635-200411000-00008
Mulholland SJ, Wyss UP. Activities of daily living in non-western cultures: range of motion requirements for hip and knee joint implants. Int J Rehabil Res. 2001;24:191–8.
pubmed: 11560234
doi: 10.1097/00004356-200109000-00004
Gupta SK, Ranawat AS, Shah V, Zikria BA, Zikria JF, Ranawat CS. The P.F.C. sigma RP-F TKA designed for improved performance: a matched-pair study. Orthopedics. 2006;29:S49–52.
pubmed: 17002149
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;15:350–5.
pubmed: 17072657
doi: 10.1007/s00167-006-0202-y
Choi YJ, Lee KW, Ha JK, Bae JY, Lee SK, Kim SB, Seo DK. Comparison of Revision Rates due to aseptic loosening between high-flex and conventional knee prostheses. Knee Surg Relat Res. 2018;30:161–6.
pubmed: 29843201
pmcid: 5990236
doi: 10.5792/ksrr.17.071
Crawford DA, Adams JB, Hurst JM, Berend KR, Lombardi AV. Jr. Ten-year minimum outcomes and Survivorship with a high flexion knee system. J Arthroplasty. 2019;34:1975–9.
pubmed: 31104836
doi: 10.1016/j.arth.2019.04.039
Huang HT, Su JY, Wang GJ. The early results of high-flex total knee arthroplasty: a minimum of 2 years of follow-up. J Arthroplasty. 2005;20:674–9.
pubmed: 16310007
doi: 10.1016/j.arth.2004.09.053
Kim YH, Park JW, Jang YS. 20-Year minimum outcomes and survival rate of High-Flexion Versus Standard Total Knee Arthroplasty. J Arthroplasty. 2021;36:560–5.
pubmed: 32854994
doi: 10.1016/j.arth.2020.07.084
Weeden SH, Schmidt R. A randomized, prospective study of primary total knee components designed for increased flexion. J Arthroplasty. 2007;22:349–52.
pubmed: 17400089
doi: 10.1016/j.arth.2006.04.007
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.
pubmed: 20668837
doi: 10.1007/s00167-010-1218-x
D’Lima DD, Steklov N, Fregly BJ, Banks SA, Colwell CW. Jr. In vivo contact stresses during activities of daily living after knee arthroplasty. J Orthop Res. 2008;26:1549–55.
pubmed: 18524001
doi: 10.1002/jor.20670
Nakayama K, Matsuda S, Miura H, Iwamoto Y, Higaki H, Otsuka K. Contact stress at the post-cam mechanism in posterior-stabilised total knee arthroplasty. J Bone Joint Surg Br. 2005;87:483–8.
pubmed: 15795197
doi: 10.1302/0301-620X.87B4.15684
Shiramizu K, Vizesi F, Bruce W, Herrmann S, Walsh WR. Tibiofemoral contact areas and pressures in six high flexion knees. Int Orthop. 2009;33:403–6.
pubmed: 18034243
doi: 10.1007/s00264-007-0478-7
Suggs JF, Kwon YM, Durbhakula SM, Hanson GR, Li G. In vivo flexion and kinematics of the knee after TKA: comparison of a conventional and a high flexion cruciate-retaining TKA design. Knee Surg Sports Traumatol Arthrosc. 2009;17:150–6.
pubmed: 18839144
doi: 10.1007/s00167-008-0637-4
Kim YH, Park JW, Kim JS. High-flexion total knee arthroplasty: survivorship and prevalence of osteolysis: results after a minimum of ten years of follow-up. J Bone Joint Surg Am. 2012;94:1378–84.
pubmed: 22854990
doi: 10.2106/JBJS.K.01229
Rhee SJ, Hong SM, Suh JT. High-flexion total knee arthroplasty using NexGen LPS-Flex system: Minimum 5-year follow-up results. Knee Surg Relat Res. 2015;27:156–62.
pubmed: 26389068
pmcid: 4570950
doi: 10.5792/ksrr.2015.27.3.156
Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393:655–63.
pubmed: 30782341
pmcid: 6381229
doi: 10.1016/S0140-6736(18)32531-5
Radetzki F, Wienke A, Mendel T, Gutteck N, Delank KS, Wohlrab D. High flex total knee arthroplasty–a prospective, randomized study with results after 10 years. Acta Orthop Belg. 2013;79:536–40.
pubmed: 24350515
Choi BS, Kim JM, Han HS. Decision-making factors and their thresholds for total knee arthroplasty in lateral tibiofemoral osteoarthritis patients: a retrospective cohort study. Knee Surg Relat Res. 2022;34:41.
pubmed: 36274181
pmcid: 9590191
doi: 10.1186/s43019-022-00168-w
Lee YM, Kim GW, Lee CY, Song EK, Seon JK. No difference in clinical outcomes and survivorship for robotic, navigational, and conventional primary total knee arthroplasty with a Minimum follow-up of 10 years. Clin Orthop Surg. 2023;15:82–91.
pubmed: 36779002
doi: 10.4055/cios21138