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Patient-perceived knee enlargement after total knee arthroplasty: prevalence, risk factors, and association with functional outcomes and radiological analysis

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Abstract

Purpose

In clinical practice, many patients complained that their knees became larger after total knee arthroplasty (TKA), yet no studies have described this phenomenon. We named this as “patient-perceived enlargement of knee” (PPEK). This study aimed to investigate the prevalence of PPEK after TKA; assess the association between PPEK and demographics, surgical options, or component size; assess the influence of PPEK on patient satisfaction and functional outcomes; and determine whether there was radiological difference between patients with or without PPEK.

Methods

We reviewed patients that underwent unilateral primary TKA between May 2018 and April 2019. We investigated the prevalence of PPEK and acquired functional scores and satisfaction. Patients were divided into two groups according to whether they complained of PPEK. In radiological evaluation, we measured anterior and posterior condyle offset (ACO and PCO) of the femur, tibial coverage lines, tibial overhanging lines, and femoral overhanging lines.

Results

A total of 389 patients were enrolled and 101 patients felt their knee became “larger” after TKA. Patients with PPEK had significantly shorter height and lower weight, yet component size distribution showed no statistical difference. Patients with PPEK had significantly lower functional scores and satisfaction. Patients with PPEK had significantly larger ACO, shorter postoperative PCO, more ACO increase, and less anterior underhang of the tibia.

Conclusion

PPEK is common in TKA patients, especially in individuals with smaller height and weight. PPEK is associated with poor satisfaction and lower functional scores. In radiology, post-operative ACO, PCO, and anterior underhang of the tibial component were correlated with PPEK.

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Acknowledgements

We thank Ms Jinqing Zhang for the management of database. We also thank Editage (www.editage.com) for language editing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China

    Hanlong Zheng, Hongyi Shao, Qiheng Tang, Shengjie Guo, Dejin Yang & Yixin Zhou

Authors
  1. Hanlong Zheng
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  2. Hongyi Shao
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  3. Qiheng Tang
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  4. Shengjie Guo
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  5. Dejin Yang
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  6. Yixin Zhou
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hanlong Zheng, Shengjie Guo, Qiheng Tang, and Dejin Yang. The first draft of the manuscript was written by Hanlong Zheng and revised by Hongyi Shao and Yixin Zhou. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yixin Zhou.

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This study was approved by ethics committee of Beijing Jishuitan Hospital, Beijing, China.

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Informed consent for study participation was obtained from all study participants.

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Publication was approved by all the authors and the institute.

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The authors declare no competing interests.

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Zheng, H., Shao, H., Tang, Q. et al. Patient-perceived knee enlargement after total knee arthroplasty: prevalence, risk factors, and association with functional outcomes and radiological analysis. International Orthopaedics (SICOT) 46, 1305–1312 (2022). https://doi.org/10.1007/s00264-022-05388-z

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  • DOI: https://doi.org/10.1007/s00264-022-05388-z

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